Rental Form

Basic information Name * Email * Phone number * Rental information Rental start date 12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 20122013 Estimated end date 12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 20122013201420152016201720182019202020212022 Plan 200 minutes. $29.90 400 minutes. $49.90 1000 minutes. $95.00 2000 minutes. $145.00 3000 minutes. $195.00 21 cents/minute $1/day No phone- Internet only Rentals Quantity 1 2 3 4 5 5+ Cell phone Rent - FREE with any package or $1 a day for Pay As You Go Buy ($89 for Nokia 1616) SIM only (50 cents/Day) Blackberry ($8.90/day) No phone - Modem only Add-ons Insurance (50 cents/Day) US number (Only $6/Month) Internet modem $6/Day No thanks 1 2 3 4 5 5+ Delivery Information Delivery Method 14 days - $9.90 10 days - $14.90 3 days - $24.90 Over night - $35 Street & house number City & State Zip code Country USA Israel Other Special requests