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
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
First Month Appliance Rental Price: $46.99
Delivery and Installation Fees Price: $35.00
Tax Price: $8.16
First Month Total Payment Price: $107.05

Your Regular Monthly Payment

Monthly Appliance Rental Fee Price: $46.99
Regular Monthly Total Price: $57.35
Tax Price: $4.37

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?
Total

Terms and Conditions

Payment Information

Please Note: Upon approval of this Request for Delivery application, the credit card you provide will be securely stored for future payments. Your initial payment will not be charged and processed until one business day before your scheduled delivery.
Payment
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