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| Address | City | ||
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| Credit Card Type | Credit Card# | ||
| Credit Card Experation | Deposit Type | ||
| Employer Name | Employer Phone | ||
| Employer Address | Employer City | ||
| Employer Zip | Car License # | ||
| Equip. Request Date | Equip. Return Date | ||
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| Quantity | Description | Days | Minimum 4-Day Rate | 8-Day Rate | Addational Days | Deposit | Line Total |
| Family Tent - Coleman 9' x 17' Cabin Tent | $44.00 | $77.00 | $11.00 | $150.00 | |||
| Tent - COleman 10' x 10' 5-Person Dome Tent | 28.00 | 49.00 | 7.00 | 90.00 | |||
| Backpack Tent - Coleman 7' x 7' 3-Person Dome Tent | 20.00 | 35.00 | 5.00 | 50.00 | |||
| Sleeping Bag - 3 1/2 lb. Hollofil II Rect. | 20.00 | 35.00 | 5.00 | 50.00 | |||
| Sleeping Bag - 3lb. Hollofil II Tapered | 20.00 | 35.00 | 5.00 | 50.00 | |||
| Cot - 24" x 72" Aluminum | 10.00 | 17.50 | 2.50 | 15.00 | |||
| Stove - Coleman 2 burner propane | 12.00 | 21.00 | 3.00 | 30.00 | |||
| Lantern - Coleman Double Mantel Propane | 8.00 | 14.00 | 2.00 | 15.00 | |||
| Cooler - Coleman 68 Qt. | 10.00 | 17.50 | 2.50 | 25.00 | |||
| Backpack - Coleman Peak 1 | 20.00 | 35.00 | 5.00 | 60.00 | |||
| Youth Backpack - Coleman Peak 1 | 16.00 | 28.00 | 4.00 | 45.00 | |||
| Air Mattress - Thermarest Self-inflating | 14.00 | 24.50 | 3.50 | 35.00 |
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