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Client Billing Form

* Denotes Required Field

Unit Number *
Operator: *
Contact Name: *
Contact Phone: *
Well Name: *
Well Location: *
AFE Number: *
Rig Number: *
Wellsite Geologist: *
Geologist Phone: *
Geologist Email: *
Receive a Copy of this email?:
Pick Up Date:
Rig up Date: *
Rig Down Date: *
Return Date:
The Company (Renter) is responsible for all aspects of equipment maintenance while it is the possession of the company (Renter) and agrees to return all equipment to TOTAL GAS DETECTION LTD. In the same condition it was in when initially rented. The company (Renter) agrees to be responsible for payment of any damages to or missing equipment.

Limitation of Liability
In no event shall TOTAL GAS DETECTION LTD, Nor any of its employees, be liable to the company (Renter) or any other person or entity for any direct, indirect, incidental, special or consequential damages whatsoever including but not limited to loss of revenue or profit, damages, expenses or claims by a third party resulting from any interpretation or assumption based on any information or equipment provided by TOTAL GAS DETECTION LTD.

The company (Renter) hereby agrees to the above rental agreement and terms herein and accepts full responsibility for payment of all charges by signature below of a duly authorized agent of the company for that purpose.



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