China Cell Phone Rental Form

Please note that all fields followed by an asterisk must be filled in.

Phone Rental Order Quantity

Please Choose a Phone*

	Motorola C119
	Nokia 2100
	Motorola W205
	Motorola C139
	Smartphone Android Phone with data
	iPhone 4 with data

Pre-paid Airtime Card ( $19 per card ) Order Quantity:*

Additional Data Plan for Smartphone:

Phone to be Delivered to Address: *

Contact/Hotel Name:*

Delivery Date ( Month/Day/Year ) *

Phone to be Returned to Address *

Date of Picking Up ( Month/Day/Year ) *

Gender

First Name*

Last Name*

E-Mail Address*

Country*

Business Phone*

Your Message

Please enter the word that you see below.

More Information:

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