9007 Galene Drive                                                J-Town Village Shopping Center
    Louisville, KY  40299                                      Ph:  (502) 495-6223 /  Fax:  495-6011

RENTAL AGREEMENT


NAME:  _________________________________________________          START DATE:  _____________   TIME:  _____________

COMPANY:  _____________________________________________           END DATE:     _____________   TIME:  _____________

ADDRESS:   _____________________________________________           PICKED UP   _____          OR         DELIVERED  ______

CITY, STATE, ZIP:  ________________________________________          SECURITY DEPOSIT PAID:  $_____________________

PHONE:  _____________________    CELL:  ___________________           CARDHOLDER:  ________________________________

EMAIL:  _________________________________________________           CC #:  ________________________________________

FAX:  ________________________                                                                 EXP.:  ______/______      CODE:  __________________

​____________________________________________________________________________________________________________

          MACHINE / MODEL :                                                                                                                 RENTAL FEE:             RET'D.

                                                                                                                                                           $                                      _____
____________________________________________________________________________________________________________

         MACHINE / MODEL :                                                                                                                   RENTAL FEE:            RET'D.

                                                                                                                                                            $                                     _____
____________________________________________________________________________________________________________

         MACHINE / MODEL :                                                                                                                   RENTAL FEE:           RET'D.

                                                                                                                                                            $                                     _____
____________________________________________________________________________________________________________

      ACCESSORIES & SUPPLIES:                                                               QTY.                                PRICE:                       RET'D.

                                                                                                                                                            $                                     _____
____________________________________________________________________________________________________________

      ACCESSORIES & SUPPLIES:                                                                QTY.                                PRICE:                      RET'D.

                                                                                                                                                            $                                     _____
____________________________________________________________________________________________________________

      ACCESSORIES & SUPPLIES:                                                                QTY.                                 PRICE:                     RET'D.

                                                                                                                                                            $                                      _____
____________________________________________________________________________________________________________

      OTHER  ITEM(S):                                                                                      QTY.                                 PRICE:                     RET'D.


_______________________________________________________       _________                      $___________               _____

_______________________________________________________       _________                      $___________               _____

_______________________________________________________       _________                      $___________               _____

____________________________________________________________________________________________________________

                                                                                       DELIVERY AND / OR SET-UP CHG:            $____________

                                                                                                                          PICK-UP CHG:            $____________

                                                                                                                                LATE FEE:             $____________

                                                                                                                       6% SALES TAX:             $____________


                                                                                                                                 TOTAL:         $_________


    CUSTOMER SIGNATURE:  __________________________________________________         DATE:  ___________________

    PARTY WORKS SIGNATURE:  _______________________________________________         DATE:  ___________________