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					RENTAL FORM                                                                                          Restoration Coach 1-800-550-7903
       Company                                                                                                   Date:                     /        /
       Contact

       Address                                                                                                   Restoration Assistant:

       City, State, Zip

       Phone              (              )
       Email

       Fax:               (              )                                                                       Storm Surge
Type             Code                                     Description                                  Unit(s)    Per @          Price         # days rent         Total Price
 AM R AM 1-2              Rent Air Mover for (1 or 2 days) --------------------------------->                     Each  @    $     15.00                days   $                 -
 AM R AM 3-6              Rent Air Mover for (3 - 6 days) ---------------------------------->                    Each @      $     10.00                days   $                 -
 AM R AM 7 days +         Rent Air Mover for (7 + days) ------------------------------------>                    Each @      $      8.00                days   $                 -
 AM R AM BR 100+          Rent 100+ Air Movers (Minimum 7 days) ---------------------->                          Each @      $      7.00                days   $                 -
 AM R AM BR 500+          Rent 500+ Air Movers (Mininum 7 days) ----------------------->                         Each @      $      6.50                days   $                 -
 DH R DH 200 HT 1-2       Rent Dehumidifier 200 HT (1 or 2 days) ----------------------->                        Each @      $     70.00                days   $                 -
 DH R DH 200 HT 200 3-6   Rent Dehumidifier 200 HT (3 - 6 days) ------------------------->                       Each @      $     60.00                days   $                 -
 DH    R DH 200 HT 7      Rent Dehumidifier 200 HT (7 + days) --------------------------->                       Each @      $     55.00                days   $                 -
 DH R DH 200 HT 20+       Rent DH 200 HT 20 + (Minimum 7 days) ---------------------->                           Each @      $     50.00                days   $                 -
 DH R DH BR 100+          Rent DH 200 HT 100 + (Minimum 7 days) -------------------->                            Each @      $     40.00                days   $                 -
DES R DES 385             Rent Desiccant DH 385 CFM ------------------------------------->                       Each @      $    110.00                days   $                 -
DES R DES 385 7+          Rent Desiccant DH 385 CFM (7+ days) ------------------------>                          Each @      $    100.00                days   $                 -
DES R DES 1200            Rent Desiccant DH 1200 CFM ------------------------------------>                       Each @      $    250.00                days   $                 -
DES R DES 1200 7+         Rent Desiccant DH 1200 CFM (7+ days) ----------------------->                          Each @      $    225.00                days   $                 -
DES R DES 4800            Rent Desiccant DH 4800 CFM ------------------------------------>                       Each @      $    950.00                days   $                 -
DES R DES 4800            Rent Desiccant DH 4800 CFM (7+ days) ----------------------->                          Each @      $    900.00                days   $                 -
 AC    R ACP              Rent Portable Air Conditioner ----------------------------------->                     Each @      $    110.00                days   $                 -
 AC    R ACP 7+           Rent Portable Air Conditioner (7+ days) ----------------------->                       Each @      $    100.00                days   $                 -
AIR    R ASM              Mini-Guardian Air Scrubber - HEPA Filter ---------------------->                       Each @      $     60.00                days   $                 -
AIR    R ASM 7+           Mini-Guardian Air Scrubber (7+ days) -------------------------->                       Each @      $     50.00                days   $                 -
AIR    R ASG              Guardian Air Scrubber - HEPA Filter ---------------------------->                      Each @      $     90.00                days   $                 -
AIR    R ASG 7+           Guardian Air Scrubber - (7+ days) ------------------------------>                      Each @      $     80.00                days   $                 -
 INJ   R I INJ            Rent Injectidry System w/ ad on kit -------------------------------->                  Each @      $    100.00                days   $                 -
 INJ   R INJ 7+           Rent Injectidry System (7+ days) --------------------------------->                    Each @      $     90.00                days   $                 -
HEAT R H FIRE             Rent Firebird Portable Heater ------------------------------------->                   Each @      $     70.00                days   $                 -
HEAT R H FIRE 7+          Rent Firebird Portable Heater (7+ days) ------------------------>                      Each @      $     60.00                days   $                 -
HEAT R H Etes 110         Rent E tes Portable Heater 110 Volt ----------------------------->                     Each @      $     70.00                days   $                 -
HEAT R H Etes 110 7+      Rent E tes Port Heater 110 Volt (7+ days) --------------------->                       Each @      $     60.00                days   $                 -
HEAT R H Etes 220         Rent E tes Portable Heater 220 Volt ---------------------------->                      Each @      $     90.00                days   $                 -
HEAT R H Etes 220 7+      Rent E tes Port Heater 220 Volt (7+ days) --------------------->                       Each @      $     80.00                days   $                 -
HEAT R H IF S             Rent Indirect Fired Heater Small --------------------------------->                    Each @     $                           days
HEAT R H IFHS 7+          Rent Indirect Fired Heater Small (7+ days) -------------------->                       Each @     $                           days
HEAT R H IF M             Rent Indirect Fired Heater Medium ------------------------------->                     Each @     $                           days
HEAT R H IF M 7+          Rent Indirect Fired Heater Med (7 + days) --------------------->                       Each @     $                           days
HEAT R H IF L             Rent Indirect Fired Heater Large --------------------------------->                    Each @     $                           days
HEAT R H IF L 7+          Rent Indirect Fired Heater LRG (7 + days) --------------------->                       Each @     $                           days
HEAT R HIF XL             Rent Indirect Fired Heater XL ------------------------------------>                    Each @     $                           days
HEAT R H IF XL 7+         Rent Indirect Fired Heater XL (7 + days) ----------------------->                      Each @     $                           days
EXT R E HX                Rent Hydro- X Extractor -------------------------------------------->                  Each @      $   120.00                 days   $                 -
EXT R E HX 7+             Rent Hydro- X Extractor (7+ days) ------------------------------->                     Each @      $   100.00                 days   $                 -
EXT R E VP                Rent Vac Pac GTO Portable Vacuum --------------------------->                          Each @      $   150.00                 days   $                 -
EXT R E VP 7+             Rent Vac Pac GTO (7 + days) ------------------------------------>                      Each @      $   120.00                 days   $                 -
MTR R MTR                 Rent Meter Kit -------------------------------------------------------->               Each @      $   250.00                 days   $                 -
MTR R MTR 7+              Rent Meter Kit (7+ days) ------------------------------------------->                  Each @      $   190.00                 days   $                 -
PWR R P PDB               Rent Portable Power Distribution Box ---------------------------->                     Each @      $    20.00                 days   $                 -
GEN R GEN                              KW Generator Rental --------------------------->                          Each @                                 days   $                 -
GEN R GEN                              KW Generator Rental --------------------------->                          Each @                                 days   $                 -
GEN R GEN                              KW Generator Rental --------------------------->                          Each @                                 days   $                 -
GEN R GEN                              KW Generator Rental --------------------------->                          Each @                                 days   $                 -
FUEL                      Fuel Charge ---------------------------------------------------------->                Gallon @                               days   $                 -

                                                                                                                         @ $                            days

                                                                                                                         @ $                            days

                                                                                                                         @ $                            days
PURCHASE FORM                                                                    Restoration Coach                                1-800-550-7903
Company:                                                                                 Date:                     /          /
Contact

Address                                                                                  Restoration Assistant:

City, State, Zip

Phone

Email

Fax:
Type              Code                                      Description                                  Unit(s)       Per    @        Price           Total Price       BO
  AM      AM 3.9          Air Mover 3.9 amps Viking 2200 Windstorm                                                     Each   @    $     189.00    $                 -
  AM      AM 3.9 10+      Air Mover 3.9 amps Viking 2200 Windstorm (10 + Unit Pricing)                                 Each   @    $     179.00    $                 -
  AM      AM 3.9 120+     Air Mover 3.9 amps Viking 2200 Windstorm (120 + Unit Pricing)                                Each   @    $     169.00    $                 -
  AM      AM 2.6          Air Mover 2.6 amps Viking 2200 Windstorm                                                     Each   @    $     219.00    $                 -
  AM      AM 2.6 10+      Air Mover 2.6 amps Viking 2200 Windstorm (10 - 99 Unit Pricing)                              Each   @    $     209.00    $                 -
  AM      AM 2.6 10+      Air Mover 2.6 amps Viking 2200 Windstorm (100 + Unit Pricing)                                Each   @    $     199.00    $                 -
  AM      AM 2.6 120+     Air Mover 2.6 amps Viking 2200 Windstorm (120 + Unit Pricing)                                Each   @    $     189.00    $                 -
  AM      AM 2.6 DC       Viking 2200 EX Air Mover 2.6 amp Daisy Chain                                                 Each   @    $     229.00    $                 -
  AM      AM 2.6 DC 10+   Viking 2200 EX Air Mover 2.6 amp Daisy Chain (10 + Unit Pricing)                             Each   @    $     219.00    $                 -
  AM      AM 2.6 DC 120+ Viking 2200 EX Air Mover 2.6 amp Daisy Chain (120 + Unit Pricing)                             Each   @    $     209.00    $                 -
  DH      DH 200HT        Dehumidifier Phoenix 200 LGR - High Temperature                                              Each   @    $    2,395.00   $                 -
  DH      DH 200HT 3-9    Dehumidifier Phoenix 200 LGR - High Temperature (3-9 Unit Pricing)                           Each   @    $    2,275.00   $                 -
  DH      DH 200HT 10+    Dehumidifier Phoenix 200 LGR - High Temperature (10 + Unit Pricing)                          Each   @    $    2,055.00   $                 -
  DH      DH 200HT 30+    Dehumidifier Phoenix 200 LGR - High Temperature (30 + Unit Pricing)                          Each   @    $    1,975.00   $                 -
  DH      DDH 385         Desiccant Dehumidifier Phoenix Portable D385 Processed CFM                                   Each   @    $    3,199.00   $                 -
  DH      DDH 1200        Desiccant Dehumidfier Phoenix Portable 1200 CFM (900 Processed CFM)                          Each   @    $   10,999.00   $                 -
  DH      DDH 4800        Desiccant Dehumidifier Phoenix 4800 Processed CFM                                            Each   @                    $                 -
  AC      ACP             Rent Portable Air Conditioner                                                                Each   @    $    3,150.00   $                 -
  AIR     ASM             Mini-Guardian Air Scrubber - HEPA Filter                                                     Each   @    $    1,145.00   $                 -
  AIR     ASM 3-9         Mini-Guardian Air Scrubber - HEPA Filter (3-9 Units)                                         Each   @    $    1,089.00   $                 -
  AIR     ASM 10+         Mini-Guardian Air Scrubber - HEPA Filter (10+ Units)                                         Each   @    $     995.00    $                 -
  AIR     ASG             Guardian Air Scrubber - HEPA Filter                                                          Each   @    $    1,649.00   $                 -
  AIR     ASG 3-9         Guardian Air Scrubber - HEPA Filter (3-9 Units)                                              Each   @    $    1,545.00   $                 -
  AIR     ASG 3-9         Guardian Air Scrubber - HEPA Filter (10+ Units)                                              Each   @    $    1,295.00   $                 -
  INJ     I INJ           Injectidry System - HP60 Floor Drying Package                                                Each   @    $    2,995.00   $                 -
  INJ     I ADT 9         Adaptidry 9 Port Negative Wall Drying Adapter                                                Each   @    $     795.00    $                 -
  INJ     I ADT 5         Adaptidry 5 Port Negetive Wall Drying Adapter                                                Each   @    $     495.00    $                 -
 HEAT H FIRE              Firebird Phoenix Electric Heat Drying System                                                 Each   @    $    2,349.00   $                 -
 HEAT H Etes 110          E tes Portable Heater 110 Volt                                                               Each   @    $    2,195.00   $                 -
 HEAT H Etes 220          E tes Portable Heater 220 Volt                                                               Each   @    $    2,395.00   $                 -
 EXT      E HX            Hydro- X Pad & Carpet Extractor                                                              Each   @    $    3,749.00   $                 -
 EXT      E HX 4+         Hydro- X Extractor 4 + Units (can be combined with Vac Pacs HX for discount)                 Each   @    $    3,495.00   $                 -
 EXT      E VP            Vac Pac GTO Portable Vacuum                                                                  Each   @    $    3,749.00   $                 -
 EXT      E VP 4+         Vac Pac GTO 4+ Units (can be combined with Hydro-X for discount)                             Each   @    $    3,495.00   $                 -
 EXT      E WAND          Extaction Wand                                                                               Each   @    $     349.00    $                 -
 MTR      M HMI 41        HMI 41 Thermo Hygrometer (Very Accurate Calculates GPP & Dew Point)                          Each   @    $     795.00    $                 -
 MTR      M HM 34         HM 34 Thermo Hygrometer (Very Accurate NO Calculate GPP & Dew Point)                         Each   @    $     495.00    $                 -
 MTR      M BD10          Delmhorst BD-10 Analog Penetrating Moisture Meter                                            Each   @    $     380.00    $                 -
 MTR      M BD2100        Delmhorst BD-2100 Digital Penetrating Moisture Meter                                         Each   @    $     395.00    $                 -
 MTR      M PP            Delmhorst Paddle Probe (Measure Moisture Behind Trim & Under Base Plates)                    Each   @    $     175.00    $                 -
 MTR      M 21E           Delmhorst 21-E Insulation Probe (Measure Moisture Inside of Walls)                           Each   @    $      85.00    $                 -
 MTR      M 2E            Delmhorst 2-E Extension Probe                                                                Each   @    $      75.00    $                 -
 MTR      M TRA           Tramex Moisture Encounter (Non Penetrating Moisture Meter)                                   Each   @    $     395.00    $                 -
 PWR P MPB                Power Mini Distribution Box 40 Amp 120 Volt                                                  Each   @    $     295.00    $                 -
 PWR P PB                 Power Distribution Box (Yellow Spider Box)                                                   Each   @    $     495.00    $                 -
 PWR P 4WD                Power 4 Wire Dryer Adapter - 2'                                                              Each   @    $     119.00    $                 -
 PWR P 4WR                Power 4 Wire Range Adapter - 2'                                                              Each   @    $     119.00    $                 -
 PWR P 3WD                Power 3 Wire Dryer Adapter - 2'                                                              Each   @    $     179.00    $                 -
 PWR P 3WR                Power 3 Wire Range Adapter - 2'                                                              Each   @    $     189.00    $                 -
                                                                                                   Crew Leader:
                                                                                                   Crew Leader:
                                                                                                   Service Technician
                                                                                                   Service Technician


Customer: _________________________         ____________        Claim #: ___________________________ Date:              /       /   Time: _______ am pm

          Type    Local / Storm                 Description                 Unit(s)    Per     @       Price
WRT                               Water Restoration Class Seat                1       Person   @ $      495.00              $               $
WRT +                             Water Restoration Class Seat - 2+                   Person @ $   395.00                   $               $
ASD - B                           ASD at Boldens                                      Person @ $ 1,195.00                   $               $
ASD RC                            ASD at Restoration Coach                            Person @ $ 1,195.00                   $               $
                                                                                             @                              $               $




Supervisor

Request from Supervisor



Sent Pre Class Study Guide

Special Food Request Kosher Meals

Need Hotel Room

Sent Directions

Student Name

Company
PURCHASE FORM                                                                    Restoration Coach                                1-800-550-7903
Company:                                                                                 Date:                     /          /
Contact

Address                                                                                  Restoration Assistant:

City, State, Zip

Phone

Email

Fax:
Type              Code                                      Description                                  Unit(s)       Per    @        Price           Total Price       BO
  AM      AM 3.9          Air Mover 3.9 amps Viking 2200 Windstorm                                                     Each   @    $     179.00    $                 -
  AM      AM 3.9 10+      Air Mover 3.9 amps Viking 2200 Windstorm (10 + Unit Pricing)                                 Each   @    $     169.00    $                 -
  AM      AM 3.9 120+     Air Mover 3.9 amps Viking 2200 Windstorm (120 + Unit Pricing)                                Each   @    $     159.00    $                 -
  AM      AM 2.6          Air Mover 2.6 amps Viking 2200 Windstorm                                                     Each   @    $     209.00    $                 -
  AM      AM 2.6 10+      Air Mover 2.6 amps Viking 2200 Windstorm (10 + Unit Pricing)                                 Each   @    $     199.00    $                 -
  AM      AM 2.6 10+      Air Mover 2.6 amps Viking 2200 Windstorm (10 + Unit Pricing)                                 Each   @    $     189.00    $                 -
  AM      AM 2.6 120+     Air Mover 2.6 amps Viking 2200 Windstorm (120 + Unit Pricing)                                Each   @    $     179.00    $                 -
  AM      AM 2.6 DC       Viking 2200 EX Air Mover 2.6 amp Daisy Chain                                                 Each   @    $     219.00    $                 -
  AM      AM 2.6 DC 10+   Viking 2200 EX Air Mover 2.6 amp Daisy Chain (10 + Unit Pricing)                             Each   @    $     209.00    $                 -
  AM      AM 2.6 DC 120+ Viking 2200 EX Air Mover 2.6 amp Daisy Chain (120 + Unit Pricing)                             Each   @    $     199.00    $                 -
  DH      DH 200HT        Dehumidifier Phoenix 200 LGR - High Temperature                                              Each   @    $    2,395.00   $                 -
  DH      DH 200HT 3-9    Dehumidifier Phoenix 200 LGR - High Temperature (3-9 Unit Pricing)                           Each   @    $    2,275.00   $                 -
  DH      DH 200HT 10+    Dehumidifier Phoenix 200 LGR - High Temperature (10 + Unit Pricing)                          Each   @    $    2,055.00   $                 -
  DH      DH 200HT 30+    Dehumidifier Phoenix 200 LGR - High Temperature (30 + Unit Pricing)                          Each   @    $    1,895.00   $                 -
  DH      DDH 385         Desiccant Dehumidifier Phoenix Portable D385 Processed CFM                                   Each   @    $    3,199.00   $                 -
  DH      DDH 1200        Desiccant Dehumidfier Phoenix Portable 1200 CFM (900 Processed CFM)                          Each   @    $   10,999.00   $                 -
  DH      DDH 4800        Desiccant Dehumidifier Phoenix 4800 Processed CFM                                            Each   @                    $                 -
  AC      ACP             Rent Portable Air Conditioner                                                                Each   @    $    3,150.00   $                 -
  AIR     ASM             Mini-Guardian Air Scrubber - HEPA Filter                                                     Each   @    $    1,145.00   $                 -
  AIR     ASM 3-9         Mini-Guardian Air Scrubber - HEPA Filter (3-9 Units)                                         Each   @    $    1,089.00   $                 -
  AIR     ASM 10+         Mini-Guardian Air Scrubber - HEPA Filter (10+ Units)                                         Each   @    $     995.00    $                 -
  AIR     ASG             Guardian Air Scrubber - HEPA Filter                                                          Each   @    $    1,649.00   $                 -
  AIR     ASG 3-9         Guardian Air Scrubber - HEPA Filter (3-9 Units)                                              Each   @    $    1,545.00   $                 -
  AIR     ASG 3-9         Guardian Air Scrubber - HEPA Filter (10+ Units)                                              Each   @    $    1,295.00   $                 -
  INJ     I INJ           Injectidry System - HP60 Floor Drying Package                                                Each   @    $    2,995.00   $                 -
  INJ     I ADT 9         Adaptidry 9 Port Negative Wall Drying Adapter                                                Each   @    $     795.00    $                 -
  INJ     I ADT 5         Adaptidry 5 Port Negetive Wall Drying Adapter                                                Each   @    $     495.00    $                 -
 HEAT H FIRE              Firebird Phoenix Electric Heat Drying System                                                 Each   @    $    2,349.00   $                 -
 HEAT H Etes 110          E tes Portable Heater 110 Volt                                                               Each   @                    $                 -
 HEAT H Etes 220          E tes Portable Heater 220 Volt                                                               Each   @                    $                 -
 HEAT H IF S              Indirect Fired Heater Small                                                                  Each   @                    $                 -
 HEAT H IF M              Indirect Fired Heater Medium                                                                 Each   @                    $                 -
 HEAT H IF L              Indirect Fired Heater Large                                                                  Each   @                    $                 -
 HEAT H IF XL             Indirect Fired Heater XL                                                                     Each   @                    $                 -
 EXT      E HX            Hydro- X Pad & Carpet Extractor                                                              Each   @    $    3,749.00   $                 -
 EXT      E HX 4+         Hydro- X Extractor 4 + Units (can be combined with Vac Pacs HX for discount)                 Each   @    $    3,495.00   $                 -
 EXT      E VP            Vac Pac GTO Portable Vacuum                                                                  Each   @    $    3,749.00   $                 -
 EXT      E VP 4+         Vac Pac GTO 4+ Units (can be combined with Hydro-X for discount)                             Each   @    $    3,495.00   $                 -
 EXT      E WAND          Extaction Wand                                                                               Each   @    $     349.00    $                 -
 MTR      M HMI 41        HMI 41 Thermo Hygrometer (Very Accurate Calculates GPP & Dew Point)                          Each   @    $     795.00    $                 -
 MTR      M HM 34         HM 34 Thermo Hygrometer (Very Accurate NO Calculate GPP & Dew Point)                         Each   @    $     495.00    $                 -
 MTR      M BD10          Delmhorst BD-10 Analog Penetrating Moisture Meter                                            Each   @    $     380.00    $                 -
 MTR      M BD2100        Delmhorst BD-2100 Digital Penetrating Moisture Meter                                         Each   @    $     395.00    $                 -
 MTR      M PP            Delmhorst Paddle Probe (Measure Moisture Behind Trim & Under Base Plates)                    Each   @    $     175.00    $                 -
 MTR      M 21E           Delmhorst 21-E Insulation Probe (Measure Moisture Inside of Walls)                           Each   @    $      85.00    $                 -
 MTR      M 2E            Delmhorst 2-E Extension Probe                                                                Each   @    $      75.00    $                 -
 MTR      M TRA           Tramex Moisture Encounter (Non Penetrating Moisture Meter)                                   Each   @    $     395.00    $                 -
 PWR P MPB                Power Mini Distribution Box 40 Amp 120 Volt                                                  Each   @    $     295.00    $                 -
 PWR P PB                 Power Distribution Box (Yellow Spider Box)                                                   Each   @    $     495.00    $                 -
 PWR P 4WD                Power 4 Wire Dryer Adapter - 2'                                                              Each   @    $     119.00    $                 -
 PWR P 4WR                Power 4 Wire Range Adapter - 2'                                                              Each   @    $     119.00    $                 -
 PWR P 3WD                Power 3 Wire Dryer Adapter - 2'                                                              Each   @    $     179.00    $                 -
 PWR P 3WR                Power 3 Wire Range Adapter - 2'                                                              Each   @    $     189.00    $                 -
                                                                                                                                                   $                 -
                                                                                                                                                   $                 -
                                                                                                                                                   $                 -

                                                                            Shipping                                                               $                     -
                                                                            Sub-Total                                                              $                     -
                                                                                 Tax

                                                                                                                       TOTAL                       $                     -

				
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Description: Crew Leader Tax Forms document sample