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EQUIPMENT REQUEST FORM
*
1.
First Name:
(Required.)
*
2.
Last Name:
(Required.)
*
3.
Shipping Address:
(Required.)
Ship To Name
Street Address 1
Street Address 2
City
State
Zip
*
4.
Email Address:
(Required.)
*
5.
Phone Number:
(Required.)
6.
How did you learn about our equipment rental program?
NCAT Website
Newsletter
Social Media
Referred by:
*
7.
What organization are you affiliated with?
(Required.)
*
8.
What type of equipment are you requesting?
(Required.)
VR Goggles
Paralax Drone Kit
Video Kit
Mambo Drone Kit
9.
How long would you like to use the equipment for?
One month
Two months
Three months
10.
Are you requesting the equipment for a specific event?
Yes
No
If YES please describe, (i.e. GeoTECH Conference)
11.
What is your interest/intended use with the equipment?
