Rental Equipmemt
ISLAMIC CENTER OF BATON ROUGE
ICBR EQUIPMENT RENTAL FORM
Date of Rental
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Month
-
Day
Year
Date
Date of Return
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Month
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Day
Year
Date
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I Acknowledge that the
Late Fees are $3.50 per Chair and $10.00 Per Table Per Additional Day
For Office Use Only
Equipmemt Received By
Received Date
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Month
-
Day
Year
Date
Equipmemt Return By
Return Date
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Month
-
Day
Year
Date
THE EQUIPMENT FEES ARE AS FOLLOWS
My Products
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$3.50 PER CHAIR
PER CHAIR ADDITIONAL DAY
$
3.50
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$10.00 PER TABLE:
PER TABLE PER ADDITIONAL DAY
$
10.00
Quantity
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Credit Card
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