293 Lenox Street Norwood, MA 02062 • 781-329-9006 • fax: 781-440-2623 • sales@mysticscenic.com

Please fill in the following form regarding your rental request and press the Submit button.
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Contact and Billing Information

Contact Name: *
Phone Number: * (format: xxx-xxx-xxxx)
Email Address: *
Address: *
City: *
State: *
Zip: *  
Check here if Billing Information is same as Contact Information.
Billing Name:
Phone Number: (format: xxx-xxx-xxxx)
Email Address:
Address:
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Event Information
Name: *
Date: *  
Venue/Delivery Information
**Note: Rental lecterns can only be delivered in the New England area. Check here if on-site Contact is the same as the primary contact.
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Style and Quantity
*Please reference the Lectern Rental Page when selecting styles and quantites. Please Note: Unless otherwise stated, there is only one unit available per style.
Style(s): Quantity(s):
Graphics/Signage/Color
We can produce graphics/signage to use with our rental lecterns and we can also change their color. Please indicate below if you require any of those items or services.
Additional Comments
We accept payment in the form of checks, purchase orders, American Express, Master Card and Visa.