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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)? Yes No Not Sure

Will you have DC Power (vehicle, boat, generator, etc.)? Yes No Not Sure

* 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: American Express Visa MasterCard Discover

* 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

I will pick up equipment (Delivery Address not required) Please deliver equipment View delivery charges

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:

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