Customer Information
*Name
*Company Name
Address
City, State, Zip
*Phone
Fax
*Email
Generator Site
Phone
Application Info
Date Needed:
Unit Size:
(kW) (kVA)
Volts:
Phases:
Number of Leads:
Check One:
PrimeStandby
# of Estimated Run Hours Per Day:
Length of Rental (Days/Weeks/Months):
Accessories
Check All That Apply:
Cables
Pigtails
Pigtails Qty
Delivery
OUT
DeliveryCustomer Pick-Up
IN
Pick-UpCustomer Drop-Off
Payment Method
CashCredit Card (*Visa, MC, Am. Express, Discover)Check (*subject to approval)Charge to Account # (Subject to Approval - Up to 3 Days)
*REQUIRED FIELDS