|
Thank you for submitting your request.
Please review the information below and print for your
records.
** Click to
Proceed to Step 2 - Rental Agreement **
The information on this page has been sent to Tech-Go. Completion of this form is acknowledgement you have read and agree to
the terms in our Rental Agreement.
Tech-Go requires the Rental Agreement to be signed and faxed along with photo
ID to complete the order process.
Submitted Information
| Agent/Rate
Code (use if referred by someone) |
agentratecode |
| Number
of phones required? |
numphones |
| In
which cities will the equipment be used? |
citiesused
|
| Date
equipment needed? |
Date
dateneed
Time
timeneed |
| Expected
return date? |
Date
datereturn |
| Which
Rental rate do you desire? |
rentalplan |
| Which
airtime rate do you desire? |
rateplan
|
Additional
Service
Options |
service_options
|
| Do
you wish to purchase theft protection? |
insurance |
| Data
Options |
ISP
|
| Do
you wish to rent a Pocket PC for internet and email access? |
PocketPC |
| Choose
Shipping Method |
shipbill
fedexaccount
Shipcarrier
saturdaydelivery
saturdayshipment |
| Company
or Individual: |
nameofrenter |
| Job
Title: |
JobTitle
|
| Credit
Card Billing Address:
Non-USA cards must fax
front and back of card with photo id to +1-404-671-9419
|
|
Credit
Card Billing
Address |
| Street
Line 1: |
billingaddress1 |
| Street
Line 2: |
billingaddress2 |
| City: |
billingcity |
| State/Province/Region: |
billingstate |
| Zip/Postal
Code: |
billingzip |
| Country: |
billingcountry |
|
Contact
Person |
| Contact
Person: |
companycontactperson |
| Phone: |
companycontactphone |
|
Fax: |
companycontactfax |
| Email: |
companycontactemail |
|
| Delivery
Info: |
|
Delivery
Address |
| Street
Line 1: |
deliveraddress1 |
| Street
Line 2: |
deliveraddress2 |
| City: |
delivercity |
| State/Province/Region: |
deliverstate |
| Zip/Postal
Code: |
deliverzip |
| Country: |
delivercountry |
|
Contact
Person |
| Contact
Person: |
delivercontactperson |
| Phone: |
delivercontactphone |
|
Fax: |
delivercontactfax |
| Email: |
delivercontactemail |
|
| Special
Notes |
specialnotes |
** Click to
Proceed to Rental Agreement **
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