Reserve your phone online! (U.S.A.)

Reserve your U.S.A. phone online!

Please fill out this form.

Cell Phone rental reservation. Please fill out the following information and press the 'submit' button at the bottom.

This form is for domestic (U.S.A.) reservations only. If you wish to reserve a phone for overseas use, click here.

Our delivery agent will contact you to confirm your reservation and obtain credit card information. The delivery agent will fax you the Rental Agreement, which you must sign and return before the rental starts. If you have questions about the Rental Agreement, the delivery agent will provide you answers.

Our delivery agent's call center operates seven days a week, 365 days a year to assist you with your reservation needs.

(Please note that for your protection, we do not ask for your credit card number on this form and it is not transmitted over the public Internet. Instead, phone in your credit card information to our delivery agent -- see below.)

Thank you for your business! We welcome your comments. Email your comments directly to our general manager .

Renter Information:

Note - Required fields are marked with an asterisk *

First name: *
Last name: *

Title:

Company:

Address: *

City: *
State: *

Zip Code: *

Country: *

Phone #: *
Fax #:

E-mail: *

How many units will you be needing? *

When do you need the equipment? (rental start date): *
When will you return the equipment? (rental end date): *
Where will you use the equipment (all cities and states): *

Delivery Information:

Hotel Name:
Registered Name:

Complete Address (hotel or otherwise)
City: State: Zip:
Country:
Phone <required>:
Fax:

Credit Card Information

Credit Card (we accept the following cards)
AMEX VISA Master Card Discover Diners*

Please indicate which credit card you plan to use, but DON'T enter the card number. Instead, after submitting this form, call our delivery agent at 1-800-872-7626 or +1 (703) 222-7161 and give your credit card information over the phone.

Please be sure to inform the delivery agent that you are filling out a form that has been emailed from source code R62519 (by a dealer named "WorldRoam") and make sure you give your name and return phone number.

(It is important that you identify yourself as a customer of "WorldRoam" (with a source code of R62519), so that we can follow-up on your behalf if necessary.)

Additional comments: