Rental Order Form

Submitted by admin on Fri, 10/10/2008 - 20:52

Please let us know in as much detail as possible how we can fill your rental need.
Please fill in as much of the Contact Information section as possible so that we may get in touch with you promptly.
The blanks marked with an * must be completed before submitting your form.

Date Needed: *

Number Needed: *

Rental Duration: *

Daily

Weekly

Monthly

Not Sure

Dock: *

Truck Dock

Ground Dock

Not Applicable

Use: *

Indoor/Cushion

Outdoor/Pneumatic

Fuel: *

LP Gas

Electric

Diesel

Gasoline

Largest Load: * pounds

Load Center: *

Maximum Lifting Height: * inches

Maximum Clearance: * inches

Fork Length: *

Side Shift: *

Yes

No

Attachments:

Comments:

Contact Information

Existing Account Number:

First Name: *

Last Name: *

Title:

Company: *

Department:

Preferred Contact Method:

E-mail: *

Phone: *

Alternate Phone:

Best Time To Call:

Address Line 1:

Address Line 2:

City:

State: *

Zip:

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R&J Midwest Equipment · 1090 Fargo Ave. · Elk Grove Village, IL 60007 · Phone: 847-290-8081 · Fax: 847-290-8021

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