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3. EQUIPMENT RENTAL REQUEST FORM BCS TWO-WHEEL TRACTOR
5. Name
6. Email Address
8. Address
10. City
11. State
12. Zip Code
14. Phone Number
15. Dates Requested
17. EQUIPMENT REQUESTED:
19. TRACTOR, PLUS:

    1. Tiller
    2. Rotary Plow
    3. Barden Bed Shaper
    4. Hiller/Furrower
    5. Plastic Mulch Layer (must provide own sheeting)
21. Address where equipment to be used:
23. What will you be using the equipment for?
25. Have you already attended the required "EQUIPMENT DEMONSTRATOION WORKSHOP"?

    1. Yes
    2. No
27. **"All applicable owners manuals will be forwarded to you via email. Please read them prior to your delivery date.
29. _____ I have read and understand the "Procedures for Rental/Use of the BCS Tractor"
31. _____ I have completed the "BCS Shared Equipment Lease" agreement.
33. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
35. I Agree

    1. Electronic Signature
39. INTERNAL USE ONLY
41. Date Request Received: _________________
42. Received By: ___________________________
43. 1. Availability Confirmed
    2. Customer notified
    3. Contract Executed
    4. Customer Contacted 24 hrs. prior to delivery
45. Copy of Government Issued ID Attached ______ Yes _______ No
47. APPROVED:
49. ____ Yes
51. ____ Yes, with the following modifications ___________________________________________________________________________________
53. ____ No (Reason) _____________________________________________________________________________________________________________
56. 158 Rafters Lane Warrenton, NC 27589 p (252)-257-3640 f (252)-257-5616
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58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

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