First Name:
Your Email:
Comments or Questions:
Billing Information:
Last Name:
(name and address must match credit card)
Company:
Address:
City:
State:
Country:
Zip/Postal Code:
Delivery Information:
Check if same as billing information
First Name:
Last Name:
Company:
Address:
City:
State:
Zip/Postal Code:
Country:
Contact Information:
Evening Phone:
Daytime Phone:
Contact Name:
Send Billing Statement Via: (check one)
Email:
FAX:
Standard Mail:
FAX #:
($2.00 Charge Applies)
Credit Card Information:
Number:
Expiration Date:
(mm/yy)
3 or 4 digit CVV: (what's this?
(We do not accept debit or check cards)
(your information is transmitted to us securely)
Travel Details:
Date of Your Departure:
Date Of Return:
# Of Phones Needed:
Countries to be visited:
Rental Choice: (please choose all that apply)
Cell Phone
Blackberry
Satellite Phone
GPS
2-Way Radio
Optional Choices:
Insurance:
YES
NO
(Yes, $1.50 per day / $75 deductible
No, $350 fee for non-insured loss of equipment)
Travel With U.S. Number?
YES
NO
On what search engine did you find us?
Comments and Questions:
(your phone will be delivered at least 2 days before departure date)
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-
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Terms and Conditions: A credit card authorization of $300 will be processed. This is NOT a deposit or a charge taken from your card. By placing this order, I hereby authorize my signature for the above rental agreement and agree to the terms and conditions of rental and authorize ICS to bill all applicable rental charges associated with this agreement to my credit card provided above.
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