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2. Equipment Rental Request Form Great Plains 706NT No-Till Drill
4. First Name
5. Last Name
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Fax Number
16. Email Address
18. Address where equipment will be used*
20. Dates Requested*
22. I have read and understood the Procedures for Rental/Use of the Great Plains 706NT No-Till Drill*

    1. Yes
    2. No
24. I have completed the No-Till Drill Equipment Lease Agreement*

    1. Yes
    2. No
26. 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.
28. I Agree *

    1. Electronic Signature
32. INTERNAL USE ONLY
34. Date Request Received _____________________________
35. Received By: _________________________
36. Copy of Government Issued ID Attached ______
38. APPROVED:
40. ____Yes
42. ____ Yes, with the following modifications ___________________________________________________________________________________
44. ____ No (Reason) _____________________________________________________________________________________________________________
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field