Helium Rental Form

Be advised that all field with star * mark mark are require to send this form successfully.

Sender full name:

Business name:

Email:

Phone number 1:

Phone number 2:

> Billing payer info (needs to match your credit card)
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Payer full name:

> Drop-off/Pickup/Return info:
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Hours Days Months

Drop-off/Pickup date:

Drop-off/Pickup time frame:

Pickup/Return date:

Pickup/Return time frame:

> List of rental items:
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Details & special instructions: (Optional)

Agree to the terms of service?