Duplicate Order Request

Duplicate Order Request - Customer does not receive an automated copy of this form.

RC Staff ID #: *
Q: May I have your First & Last Name?: *
Q: When was the last time you placed an order? *
Q: And, whats the reason for renting a second calculator?: *
Q: And, did you want to place your order today?: *Yes
No
Q: Ok, and how or where did you hear about the program? *
E-mail Address: *
Ok, your authorization code is ( Duplicate 015951). And your code will expire in (choose: 24hrs from today OR on the date they plan on placing their order): *
Message or Notes (optional):
* Required