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Customer Address
Use same address for billing
Billing Address
Additional Information
NAME OF HOSPITAL FACILITY CLINIC PROFESSIONAL REFERRED BY
*
Terms and Conditions
Enter contact information for the person
PICKING UP THE ORDER
.
Enter phone number in
555-123-5678
format
INCLUDING DASHES
. Please add
DASHES
if using Autofill.
We do not ship items. Customer address is required per our loan agreement.
You will not be billed for borrowing items. Please check Use same address for billing.
You will receive an email through
EZRentOut
to complete your registration. Please check all inboxes, including Gmail promotions.