Equipment Loan Request Form Note: Please read the Equipment Loan Agreement before submitting your loan request. Equipment loan request "*" indicates required fields About youYour legal name*Your phone number*Your e-mail address* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code About the loanPurpose of loan/event name*Location/where equipment will be used.*Start Date* Month Day Year Pickup time* Hours : Minutes AM PM AM/PM End Date* Month Day Year Dropoff time* Hours : Minutes AM PM AM/PM Equipment Loan Agreement Confirmation*Please read the Equipment Loan Agreement found at https://www.burningflipside.com/about/documents/equipment-loan-agreement before submitting your request. I have read, understand, and agree to the terms outlined in the Equipment Loan Agreement. EquipmentEquipment details*QuantityDescriptionUnit price Add RemoveUse estimated replacement value for unit price. Add rows as needed.NameThis field is for validation purposes and should be left unchanged. Δ
