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Providing Quality 2-Way Communications
Keller Communications Inc.
©1975 - Keller Communications Inc.
Rental Request Form
Company Name:
 
First Name:
 
Last Name:
 
Phone:
 
Ext:
Email:
 
Billing Address:
 
City:
 
State:
 
Zip:
 
Contact Number:
 
Pick Up Date:
 
Return Date:
 
Number Of Radios:
Number Of Headsets:
Number Of Speaker Mics:
Number Of Channels Needed:
Choose Location Radios Will Be Used:
Other Location Not Specified In List Above:
Additional Comments:
Enter The Security Code
Initial
 

 
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.
<<< I understand my Responsibilities mentioned below!!!

0155234
Secuity Code