V.I.P. Child Car Seat Rentals Inc.

Reservations

* Required Fields

* First Name:
* Last Name:
Company Name :
Address:
City / Town:
Province / State:
Country:
Postal Code / Zip:
Telephone Number:
Fax Number:
* Email Address:

Equipment Needed to Rent: (enter quantity beside each item required)	Evenflo Embrace™ 5 Deluxe Infant Car Seat Evenflo Titan™ Elite Convertible Car Seat Evenflo Chase™ DLX Booster Car Evenflo SightSeer™ Comfort Touch® Booster Car Seat Evenflo Comfort Dimensions™ Plus Stroller Evenflo BabySuite™ Classic Playard Evenflo Snap™ High Chair
What date do you require these items:	Month: Day: Year:
What is the intended date of return:	Month: Day: Year:
Do you wish to have the items delivered to where you are staying. (48 Hours notice required) Please enquire about charges, as they are in accordance with the location of delivery:	No Yes
Method of Payment: (a VIP Child Car Seat Representative will contact you regarding payment after your reservation is submitted for approval)	Visa Master Card Amex Cheque Cash
Contact information (name, address & telephone #) of where you wish items delivered and picked up:
How did you hear about us: