Keller Communications Inc.
Company Name:
First Name:
Last Name:
Phone:
Ext:
Email:
Contact Number:
Billing Address:
City:
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Choose Dates for Rental!
Pick Up Date:
Return Date:
Number Of Radios:
Number Of Headsets:
Number Of Ear Pieces:
Number Of Speaker Mics:
Number Of Channels Needed:
Choose Location Radios Will Be Used:
Other Location Not Specified In List Above:
Additional Comments:
Initial

<<< I understand my Responsibilities mentioned below!!!
Any Rental Equipment Not Returned On The Agreed Return Date Will Be
Charged A Daily Rate Until Equipment Is Returned At The Agreed Contract Daily Rate. Any Equipment Lost Or Damaged Will Be Your Responsibility And Be Repaired Or Replaced At Your Expense.


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