Fill out the order form

You may submit this form on-line or fax it to 1-810-454-1990.

Please fill out the form below so we may reserve your phone. Please complete all applicable fields below to reserve your phone(s) and arrange for shipment. After you submit this form, you will have the option of giving credit card payment information via our secure website. If you prefer to fax your credit card information, you may provide it on the required Renal Agreement form.

Completion of this form is acknowledgement you have read and agree to the terms in our Rental Agreement.

Agent/Rate Code (if referred)
Number of phones required
In which countries will the equipment be used
Date you want equipment to arrive Date: Time:

Shipping Advice: Fedex provides the following guarantee or you will receive a credit for the shipping cost: You will receive your delivery by 10:30 am for Next Business Day service and 7:30 pm for Second Business Day service. If you need your order to arrive prior to the Fedex's delivery time, you should enter a date that requests the phone to be delivered 1 day earlier.
Expected date you will return-ship
Do you need to call international numbers
(outside the USA)?

(check if yes) Click to view International Rates

Phone comes with prepaid international balance of $25 and you will charged for what you use. You may request additional international prepaid (non-refundable) during your rental which will be added within 24 hours of request. If you would like to add additional international prepaid prior to shipment, please enter total amount to load in multiples of $25 (non-refundable): $

Which Rental rate do you desire? $4 per day
Which airtime rate do you desire?
$0.50 per minute Minimum of 20 minutes * days rented (usable anytime), extra minutes at same rate
$0.75 per minute Minimum of 3 minutes * days rented (usable anytime), extra minutes at same rate
$1.25 per minute No minimum minutes
Minimum minutes are "pooled" for the rental period. For example: 7 days on the $.75 plan would result in a minimum of 21 minutes usage billed for the week - You can use these pooled minutes anytime during the rental period.
Service Options
USA Toll-Free Number. Do you desire a toll-free number for $.20 a minute extra for incoming calls and to check messages. Setup fee of $5.00 is charged to set up forwarding. Incoming calls from Pay phones incur an FCC mandated surcharge of $.30 per call.
Deluxe USA Toll-Free Number + email send/receive over-the-phone + fax forwarding. Do you desire a toll-free number, the ability to hear and respond to email over the phone, and fax receive / forwarding for $.40 a minute extra? Charge is for incoming calls, checking messages and fax receive and forwarding. Setup fee of $5.00 is charged to set up service. Incoming calls from Pay phones incur an FCC mandated surcharge of $.30 per call.
Canada Option allows you to make and receive calls in Canada for your selected rate plan above. Cost is $2 a day * days rented.
Receive unlimited emails/text messages on Phone (in digital areas only) You will be assigned an email address which allows delivery of up to 120 characters. Supported in AT&T Digital service areas which includes most major USA cities. Cost is only $10 setup fee with no daily charge - includes unlimited messages.
Do you wish to purchase theft protection? $2 per day
Reduces liability for theft/loss of phone by 50% - (highly recommended since phone replacement cost can be from $250 to $500). See Rental Agreement for details.
Do you wish to rent a hands-free headset?
Yes ($1 per day)
Increases Sound Quality! Avoid tickets in areas where it is illegal to take hands off wheel for phone use! Headset that converts from headband to over-the-ear style. Noise-canceling microphone for crystal clear calls. Easy hands-free conversations . Convenient inline volume and mute control.
Do you wish to rent a Pocket PC for internet and email access?
Yes ($50 per week)
Provides web browsing and email access via landline and wireless phone (if used with data cable above). Includes Pocket Word, Excel and Powerpoint. Requires additional $900 deposit. Limited availability. Recommend ISP Account for $3 a day so unit can be pre-configured for your use.
Choose Shipping Method
Orders placed Monday through Friday must be received by 3:00 pm EST for same day processing. All shipping/handling charges are for a single phone. Additional phones shipped cost an additional $5.00 per unit.
Billing
I would like to provide my own Fedex Account #
Fedex
Cost is for a single phone shipped. Additional units cost an additional $5 per unit.
2nd Business Day (delivery by 7:30 pm) - Cost $10 shipping/handling
Next Business Day (delivery by 10:30 am) - Cost $25 shipping/handling
Next Business Day (delivery by 8:00 am) - Cost $50 shipping/handling. Please provide special early delivery/receiving instructions for delivery between 6:00 am and 8:00 am (below)

Saturday Shipments or Deliveries
Orders for Saturday shipments out must be received by 12:00 pm EST for same day processing.
Check for Saturday delivery - add $10
Check for Saturday shipment out- add $10
Name of Renter (Cardholder)
Card Type
Expiration Date Month: Year:
Card Number
Delivery Address
Company
Street Line 1
Street Line 2
City
State/Province/Region
Zip/Postal Code
Country
Special Instructions
 
 
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