mid america productions
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Equipment Rental Form

Fields marked with a "•" are required. Thank you!

•Name:    
•Address: Apt#:  
•City: •State: •Zip:
•Phone: ( )    
•Email:    

•Check all the relevant items you wish to rent. You may choose as many as apply:

Camera(s)
Wired Microphone(s)
Wireless Microphone(s)
Video/Data Projector(s)
Projection Screen(s)
VCR/VTR(s)
TV/Monitor/Combo Unit(s)
Audio Mixer(s)
Audio Player/Recorder(s)
Speakers
Amplifier(s)
Other

Please specify the dates that you will need the equipment:
From:  
To:      
I prefer to be contacted by:       Phone      Email
Please enter any other comments or questions you have concerning your rental in the area provided below: