Place Order

To complete your request, please fill out the information below.

Please note: Upon approval of this request for the delivery application, the banking information you provide will be securely stored for future payments. Your security deposit ($75), delivery and installation fee ($50), and first month payment ($55) are due prior to delivery.

Request for Delivery

Address Information

First
Last

Address Information

Address
Address
APT
City
State/Province
Zip/Postal

Personal / Reference

Employment Information

Request for Delivery – Residential

What Are You Interested In?
Equipment Requested

Delivery Details

Delivery and Installation Fees
(Free delivery when you write a Google review)
Security Deposit $75
Refundable at the end of the lease if the machines are returned in good condition
Tax Price: $3.44
First Month Total Payment Price: $183.44

Your Regular Monthly Payment

Monthly Appliance Rental Fee Price: $55.00
Tax Price: $4.37
Regular Monthly Total Price: $58.44

Special Instructions
Special Instructions

Additional Rental Requirements

Requirements
Requirements
Is your unit located above floor/ground level?
Does your unit have access to an elevator?

Terms and Conditions
ACH Authorization Clause
Renter’s Insurance Acknowledgment
Request to Relocate Machines

Contact Information

First
Last
Time

NOTE: Relocations are not done same day; pickup will be first and then delivery will be the following day.

Address Information
Address
Address
City
State/Province
Zip/Postal
Country

New Address (where you'd like the appliance to be moved to

Relocation Details
Written Permission to Enter
Pet Containment
Special Instructions
Is your unit located above floor/ground level?
Does your unit have access to an elevator?

Please read and the Conditions below and check to indicate your agreement.

Service Charge
Dry-Run Fee
Total

Request for Pickup

Contact Information

First
Last
Time

NOTE: Relocations are not done same day; pickup will be first and then delivery will be the following day.

Address Information
Address
Address
City
State/Province
Zip/Postal
Country

Pickup Details

Available Items
Special Instructions
Pet Containment
Is your unit located above floor/ground level?
Does your unit have access to an elevator? *

Please read and the Conditions below and check to indicate your agreement.

Dry-Run Fee
Remaining Days Billing
Cleaning Fee
Total

Request for Maintenance

Contact Information

First
Last
Time

Address Information
Address
Address
City
State/Province
Zip/Postal
Country

Maintenance Details

Written Permission to Enter
Pet Containment

Please read and the Conditions below and check to indicate your agreement.

Dry-Run Fee
Total