Please indicate below:
  • The date and time for delivery of the loaned equipment, and the date and
       time for us to pick up the equipment when you are through using it;
  • Your contact information; and
  • The specific items you wish to borrow.

NOTE: Fields marked * are required.
Delivery Date:* Delivery Time:*
Pickup Date:* Pickup Time:*
First Name:* Last Name:*
Email:* Telephone:
FAX: Building:
Floor#: Room#:
 ?   Customer ID:* Approved:

Items to Borrow Quantity Comments
Tables
Chairs
Trash Cans
Hand Trucks
Dollies
Moving Lifts
Pinch Bars

If you have any additional comments, provide them in the space below: