Equipment Rental Agreement Global Test Supply
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EQUIPMENT RENTAL AGREEMENT
Please fax back to 910-401-1114
Company Name
Phone
Contact Name
Fax
Address 1
Email
Address 2
WWW
City, State
Postal Code
Type of Business
Sole Proprietorship
Partnership
Corporation
Tax Id: _____________ Inc. State:__________
Partners or
Name
Title
Social Security Number
Corporate Officers
PAYMENT INFORMATION
Credit Card Type
Amex
VISA
MasterCard
Credit Card Number
CVV (security code)
Credit Card Expiration Date
Name on Credit Card
Credit Card Billing Address
Billing Address:
Check here if same as above.
EQUIPMENT
ITEM
EQUIPMENT DESCRIPTION
S/N
RATE
TERM
SUB TOTAL
1
2
3
4
TOTAL
I hereby confirm that I have read and understood the entire Equipment Rental Agreement and that I agree to all the terms and
conditions as provided for in the Agreement. I further confirm that all the information provided by me is true and correct and that
I am authorized by stated Company to sign this agreement.
Print Name
Title
Signature
Date
3310 Kitty Hawk Rd
Suite 100
Wilmington, NC 28405
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Parent category: Legal