EQUIPMENT RENTAL AGREEMENT FORM
(This form rental agreement is to be agreed to electronically by customers when booking online)
Renter must be a Major Credit Card Holder and sign this Medical Equipment Rental Agreement.
AdaptAbility Store Inc. (AdaptAbility) rents to Renter signing this agreement medical equipment subject to all the terms set forth in this Rental Agreement and Renter agrees:
- The medical equipment is the property of AdaptAbility and is in good condition. Renter shall return equipment in the same condition as when received to AdaptAbility, at the end of the rental period for inspection, or sooner, upon the demand by AdaptAbility. AdaptAbility may repossess the medical equipment without demand at any time if it is used in violation of the terms of this agreement.
- AdaptAbility shall not be liable or responsible for the loss of or damage to any property left, lost, damaged, stolen, stored or transported by Renter, its agents, servants, or employees, or any other person on or using the medical equipment, either before or after the return thereof to AdaptAbility. Renter assumes all risk of such loss or damage and waives all claims against AdaptAbility by reason thereof and Renter agrees to hold AdaptAbility harmless from and to defend and indemnify AdaptAbility against all claims based upon or arising out of such loss or damage.
- Renter assumes all risk and liability for any loss, damage or injury, including death, to persons or property of Renter, Patient, or others arising out of the use or operation of the medical equipment.
- Renter is responsible for the medical equipment and will reimburse AdaptAbility, Legal Owner of Equipment, for the full cost of replacement upon demand for any damage, loss, theft, or destruction of the medical equipment. The Renter understands and authorizes that AdaptAbility will charge the credit card used for any repair costs or the replacement costs of the medical equipment deemed necessary.
- The following restrictions are cumulative and each shall apply to every use, operation of the medical equipment. Under no circumstances shall the medical equipment be used, operated by and person: a) while under the influence of intoxicants or narcotics; or b) in an unsafe manner.
- Renter/ Patient shall defend, indemnify and hold harmless AdaptAbility, all of their agents, officers, servants, and employees from and against any and all losses, liability claims, damages, injuries, demands, actions, and causes of action whatsoever, arising out of or related to any loss, damage or injury claimed by persons that may arise from the use, operation or driving of the medical equipment, provided that such loss or damage was not caused by the fault or gross negligence and willful misconduct of AdaptAbility or its employees.
- Renter assumes all costs and expenses of every kind and nature, including legal fees and disbursements arising out of and in connection with the use or operation of the medical equipment.
- AdaptAbility assumes no liability or responsibility for any acts or omissions of Renter/Patient or of Renter’s/ Patient’s agents, servants, or employees.
- Renter shall notify AdaptAbility immediately of any and all accidents and damage resulting from the use or operation of the medical equipment.
- Renter of the medical equipment shall in no event be deemed the agent or employee of AdaptAbility in any manner or for any purpose whatsoever.
- Any individual executing this agreement as Renter in a representative capacity shall be bound personally, jointly and severally, with such fiduciary, corporation or other entity as to all obligations, expressed or implied, arising hereunder.
- This agreement shall be binding upon the distributees, heirs, and next of kin, executors, administrators and personal representatives of the undersigned Renter.
- We reserve the right to refuse renting to anyone if deemed necessary due to various reasons.
- If Renter and or Patient fails to perform any obligation when due under this agreement, or otherwise defaults, AdaptAbility has the right to terminate this agreement forthwith by notice to the Renter. Upon such termination, (I) the balance of the Gross Rental Amount will be due and payable immediately and, (ii) AdaptAbility has the right, at its option, to take possession of and remove the Equipment from service immediately. Any other damages or amount chargeable to the Renter shall be immediately due upon such termination. If the Equipment is not immediately recoverable, the Renter will immediately forfeit the Stipulated Equipment Value.
- Renter agrees for the credit card provided to be charged one month’s rental, plus applicable tax, if equipment is not returned prior to due date or monthly rental amount is not received on or before the due date.
- Renter agrees to pay all costs, expenses, and attorney’s fees incurred by AdaptAbility in collecting sums due or in regaining possession of medical equipment or in enforcing or recovering any damage, losses or claims against Renter.
- The additional conditions outlined above have been reviewed and accepted as part of this agreement.
FIRST DATE OF RENTAL: DATE RETURNED: (Day/Month/Year) (Day/Month/Year)
MONTHLY RENTAL REOCCURING
RE-RENTAL DATE: DAY OF EACH MONTH:
DESCRIPTION OF EQUIPMENT
ITEM RENTED: ID #:
MONTHLY RENTAL PRICE: $ SECURITY DEPOSIT: $
Security Deposit (Applicable to Equipment Valued at Over $200):
Prior to taking possession of the Equipment, Renter shall deposit with AdaptAbility, in trust, a security deposit equal to one month’s rent as security for the performance by Renter of the terms under this agreement and for any damages caused by Renter or Renter’s agents to the Equipment during the Lease Term. AdaptAbility may use part or all of the security deposit to repair any damage to Equipment caused by Renter or Renter’s agents. However, AdaptAbility is not just limited to the security deposit amount and Renter remains liable for any balance. Renter shall not apply or deduct any portion of any security deposit from the last or any month's rent. Renter shall not use or apply any such security deposit at any time in lieu of payment of rent. If Renter breaches any terms or conditions of this agreement, Renter shall forfeit any deposit, as permitted by law.
If returned equipment appears broken due to misuse, a test and repair charge of $100.00 may be charged for inspection, testing and minor repairs required to return the Equipment to service. This charge will be payable at the end of this agreement. If the Equipment cannot be repaired, the Renter will be notified and will be responsible for the designated replacement cost of the Equipment.
Credit Card Payment Authorization:
By agreeing to this form, I acknowledge that I have read the rental agreement and understand the terms and conditions set forth herein. I also agree to the charges being made to my credit card and understand that if the rented item(s) is not returned on or before the agreed upon MONTHLY RENTAL REOCCURRING RE-RENTAL DATE, additional charges will be incurred.
*Payments for monthly rental items will be charged on the re-rental date of each month indicated above until the item is returned.
PRINT NAME: _____________________________________________
I authorize AdaptAbility to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.