Equipment Rental Order Bill ToName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*FaxP.O. Number Event Start Date* MM slash DD slash YYYY Event End Date* MM slash DD slash YYYY Ordered By First Last Email* Delivery ToAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Customer Name Room On-site Contact Name First Last Site Production PhoneSetup Time : Hours Minutes AM PM Meeting Start Time : Hours Minutes AM PM Meeting End Time : Hours Minutes AM PM Event End Date MM slash DD slash YYYY VideoLCD Projector HD Price: $200.00 Quantity: DVD Player Price: $50.00 Quantity: DVD Recorder Price: $75.00 Quantity: Camcorder Price: $100.00 Quantity: 34" Video Cart Price: $10.00 Quantity: 54" Video Cart Price: $20.00 Quantity: Safe Lock Stand Price: $10.00 Quantity: Camcorder Tripod Price: $30.00 Quantity: 42" Monitor Price: $200.00 Quantity: 50" Monitor Price: $250.00 Quantity: 65" Monitor Price: $350.00 Quantity: ComputerLaptop Price: $100.00 Quantity: Wireless Remote w/Laser Pointer Price: $30.00 Quantity: VGA Splitter/Amplifer Price: $50.00 Quantity: HD Splitter/Amplifier Price: $50.00 Quantity: VGA Cable Price: $30.00 Quantity: Switcher/Scaler Price: $100.00 Quantity: AudioPortable Powered Speaker Price: $100.00 Quantity: 2 Speaker Sound System Price: $200.00 Quantity: 4 Speaker Sound System Price: $300.00 Quantity: 4 Channel Mixer Price: $20.00 Quantity: 8 Channel Mixer Price: $40.00 Quantity: 12 Channel Mixer Price: $60.00 Quantity: 24 Channel Mixer Price: $100.00 Quantity: Wired Handheld Microphone Price: $20.00 Quantity: Wireless Handheld Microphone Price: $80.00 Quantity: Wireless Lavaliere Microphone Price: $80.00 Quantity: CD Player Price: $50.00 Quantity: Wood Podium Price: $75.00 Quantity: Floor Microphone Stand Price: $5.00 Quantity: Table Microphne Stand Price: $5.00 Quantity: Acrylic Podium Price: $150.00 Quantity: Audio Recorder Price: $50.00 Quantity: Audio Patch Fee Price: $25.00 Quantity: Screens6' Tripod Screen Price: $20.00 Quantity: 8' Tripod Screen Price: $30.00 Quantity: 7' 6" by 10' Fast-fold Screen Price: $100.00 Quantity: Dress Kit for Fast-fold Screen Price: $75.00 Quantity: 9' x 12' Fast-fold Screen Price: $150.00 Quantity: Flip Chart / Dry EraseFlip Chart Easel, Pad and Markers Price: $25.00 Quantity: 3' x 4' Dry Erase Board Price: $30.00 Quantity: 4' x 6' Dry Erase Board Price: $50.00 Quantity: Poster Easel Price: $15.00 Quantity: Common ItemsPower Strip Price: $5.00 Quantity: Extension Cord Price: $5.00 Quantity: Power Strip & Extension Cord Price: $10.00 Quantity: OtherPlease list other items you requireLaborLabor - 4 Hour Minimum Price: $50.00 Quantity: Holiday Labor - 4 Hour Minimum Price: $100.00 Quantity: DeliveryDelivery Charge Price: Emergency Delivery (less the 24 hrs) will incur an additional feeEstimated TotalEstimated Total $0.00
