Contact Information
First Name   Last Name
Job Title
Email
Phone  Ext

Company Information
Name
Address   City   State   Zip
Website

Product Information
PC Laptops/Notebooks Select One IBM Thinkpad Compaq Other   Qty
PC Desktop Select One IBM Compaq Dell Other   Qty
Macintosh Select One Desktop Laptop Other   Qty
Workstations Select One Compaq Dell Sun Other   Qty
LCD / Plasma Displays / Monitors Select One NEC Dell Other   Qty  
Servers Select One Compaq Dell Sun Other   Qty
Projectors Select One Epson Infocus ELMO Proxima Nec Other   Qty
Peripherals Select One HP Tektronix MISC Other   Qty
Audio / Video Select One Epson InFocus ELMO Proxima NEC MISC Other   Qty
Copy Machines Select One Free Standing Desktop Mutifunctional Other   Qty
Fax Machines Select One Desktop Multifunctional Other   Qty
Scanners Select One Free Standing Desktop Multifunctional Other   Qty
Printers Select One Laser Color Laser InkJet Dot Matrix Other   Qty

Rental Duration
Beginning Rental Date Preferred time of delivery
Ending Rental Date Preferred time of pickup
Will you need us to install/setup rental equipment for you? Select One Yes No

Rental Information
How will you be using the equipment? Select One Presentation Travel General Corporate Use Production Other

Where will the rental equipment be located (Only complete if address is different from above)
Address   City   State   Zip
Event name where equipment will be used if applicable?

Additional Comments
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