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Reservations

* Indicates a required field
 
* Equipment Package
* Airtime Package
* Date Needed
* Time Needed
* Date Finished
* Quantity Requested
* Where are you travelling?
*Country 1
Country 2
Country 3
   
* During your travels: Will you have AC Power (electricity)?
    Will you have DC Power (vehicle, boat, generator, etc.)?
* Insurance
* When do you depart?
* Create Account Number: [10 digits only, no hyphens - This is your account number]
* PIN: [4 to 6 digits] - use numbers ONLY
* Email #1:
Email #2:
Email #3:
* Billing email:
* First Name:
* Last Name:
  Company:
* Credit Card Company:
* Credit Card Number: [no hyphens, no spaces]
* Credit Card Expire Month: [2 digit code]
* Credit Card Expire Year: [4 digits]
* Card Verification Code

Delivery Options
 
Delivery Address
Billing Address (same as delivery)
* Address 1: * Address 1:
Address 2: Address 2:
Address 3: Address 3:
* City: * City:
* State/Province: [if int'l, select "none"] * State/Province:  [if int'l, select "none"]
* Country: * Country:
* Zip Code: - * Zip Code: -
* Voice phone:
Cellular Phone:
* Referred By:
Promo Code:
Comments: