QRS Rental Form-A
Rental and option to purchase a Quantron Resonance System
Ordering:To place your rental order, please fill out and mail or fax this form to:
Body Fields USA Inc.
1645 S. River Road Suite 5
Des Plaines, Illinois 60018
Fax: (847) 299-8452
Dealer: Volker Risto 00877-287-0912
Transformation Technologies
Date:
Start rental:
End rental:
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Name and Title Telephone
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Street Address
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City State Zip Code
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UPS Ground $40.00
UPS 2nd Day Air $95.00
UPS Overnight $115.00
Total Order
$ $ $Disclaimer:
No medical claims are intended or implied for any products sold. The Renter or Purchaser accepts full responsibility for the safe and proper use of the QRS system and agrees to indemnify and hold harmless the supplier and manufacturer from any consumer claims against these products or their ultimate use.
Method of Payment00/font> Check #____________________________
00/font> VISA 00/font> Master Card 00/font> AMEX
Credit Card No.________________________
Expiration Date________________________
Signature_____________________________
Terms Rental Agreement-A
Rental Fee: Prepaid $50 or $10 per week
Shipping fee includes delivery to your address.
Please call your dealer 7-days prior to the end of the contract if you would like to return the QRS.
Rental agreement for 8 weeks starting date is: _____/06 and the end date is: _____/06. If Renter does not return the QRS product(s) at the end of the contract period, the entire purchase price of $ 2790,00, less rental paid, will be billed to the Renter00 Credit Card and the QRS product(s) becomes their property.
Also, it is understood and agreed, as a part consideration hereto, that:
Renter agrees on paying the return shipping charges. Title to the QRS product(s) remain with Body Fields USA Inc. until the total purchase price, together with any other costs/expenses connected therewith, are paid. It is considered a breech of this Contract to rent or sell the QRS product(s) without the written consent of Body Fields USA Inc. during the Rental Period. Renter is responsible in the event of destruction, loss, soiling, or any damage to the QRS product(s) from any cause, and will take all necessary care in protecting and maintaining the product(s). The Renter will be charged a refurbishing fee that will not exceed the total unit price and depends upon the extent of damages. Upon Default of Payment or Breech of Contract, an amount equal to the TOTAL PURCHASE PRICE, less any payments credited to Renter00 account is due and payable, and may be charged to Renter00 credit card. If litigation is initiated, Renter agrees to pay for all legal fees, service fees, and interest as approved by the court. The Renter understands that (A) Body Fields USA Inc. makes no medical claims whatsoever regarding the use, results, or effects on the QRS product(s), and (B) some conditions require the supervision of a health care practitioner. Renter acknowledges receipt of a duplicate of this Rental Contract. It is understood that the foregoing constitutes the whole Rental Contract between the parties, and that no condition, representation, or warranty shall affect this transaction unless contained herein. We will charge a refurbishing fee if the product(s) is not returned in good order, clean in the original packaging and with all the original forms and manual and videotape. The Renter approves this contract and authorizes Body Fields USA Inc. to charge their payment(s) to the credit card (I understand that the credit card will be processed through Body Fields USA Inc.00 Credit Card Account).Renter00 Signature or write 00erbal Agreement00/b> to validate rental agreement
Rev. 3 00RF; 10/10/2006
