Rental Request form - AED Contact InformationCompany name (if applicable)Name(Required) First Last Phone(Required)Email(Required) AED RentalNumber of AED's to be rented(Required)Please enter a number from 1 to 20.AED (Hard or soft case, fast response kit, extra pads, extra battery and pediatric option)Number of days for rental(Required)1 day ($40.00)3 day ($75.00)5 day ($100.00)15 day ($300.00)20 day ($375.00)30 day ($475.00)Requested Date of Pick up(Required) MM slash DD slash YYYY Requested Pick up time(Required) Hours : Minutes AM PM AM/PM PST&GST Price: $ 0.00 CAD Total Additional Requests ( if more than 30 days needed please state here)Payment Information* Please be advised: Before rental equipment is to be picked up, a credit card hold of $1500.00 will be taken for security purposes. Credit card information will be retained until equipment is returned in good order. You will be responsible for any lost or damaged equipment. Replacement of the lost/damaged equipment will be at fair market price.
