| Name | |
|---|---|
| Address | |
| Phone | |
| Item | Quantity | Serial Number |
|---|---|---|
| Wireless Microphone | ||
| Receiver | ||
| Other Accessories |
| Rental Period | |
|---|---|
| Rental Fee | |
| Deposit | |
| Pick-up Date | |
| Return Date |
|
Renter's Signature Date:
|
Provider's Signature Date:
|