Address_______________________________________________________________________
City_______________________________________State_______Zip_____________________
Phone Number______________________Driver00 License_____________________________
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Terms: Contract#
____Cash____Check____Bankcard__________ Time & Date Out____________________
Credit Card #_____________________________ Time & Date In_____________________
Expiration Date___________________________ Total Time Out_____________________
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Serial Number____________________________ Equipment___________________________
Date Due Without Additional Charges____________________
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Quantity Item Description of Rental Rate Total Total Rental Tax Delivery Contract Total Amount Paid Balance Due Cleaning/Repairs Additional ChargesPlease Read Before Signing
Rentals are payable in advance. A charge will be added for items requiring cleaning or repair upon return. You are charged for time equipment is in your posession. Read back of form which describes all rental terms and conditions.Signature X________________________________________ Date___________________
RENTAL / TRIAL OFFER PROGRAM CONTRACT 00TERMS AND CONDITIONSSouth Florida Mobility, Inc. and/or its authorized agent(s), agrees to a Rental / Trial Offer Program to the person identified by his signature on this contract, the personal property described herein, subject to all terms and conditions of this contract. In consideration thereof, both parties acknowledge and agree as follows:
The undersigned certifies and acknowledges that he has on date and time specified, received the equipment identified in this contract. This equipment is to be used exclusively by or for the person herein identified, for the stated period of time, and is to be used solely for the purpose for which the equipment was intended. The undersigned, if the equipment is lost or damaged, will pay South Florida Mobility, Inc. the cost of replacement or repair of the equipment. The undersigned has personally inspected the equipment and found it to be in good working condition. The undersigned will immediately discontinue use of the equipment should it at any time, while in The undersigned00 possession, become in a state of disrepair, and will immediately notify South Florida Mobility, Inc. that the unit is in disrepair. South Florida Mobility, Inc. will attempt to repair any malfunction promptly at our expense. If this is not possible, then our liability is limited to refunding the entire rental fee. The undersigned, upon termination of this contract, and on the data due, will immediately return the rented equipment, along with all attachments, accessories and parts thereof to South Florida Mobility, Inc., at the address shown, in the same condition the equipment was received, ordinary wear and tear expected. If the undersigned desires to extend this contract beyond the date and time originally agreed upon, The undersigned will immediately notify the South Florida Mobility, Inc. office to obtain approval and terms for the extension. South Florida Mobility, Inc. may, at its own discretion, report as stolen all equipment not returned within five (5) days after the date listed in the 00ate Due In Without Additional Charges00section of the contract, or before that date if conditions and circumstances indicate has occurred. The undersigned will pay all collection fees, court costs, attorney00 fees, and/or any other expenses required to enforce this contract. 00AVE HARMLESS00 Irrespective of any insurance, the undersigned agrees to assume all risk and agrees to indemnify and hold harmless from and against any claim, legal cost or cause of action for death or injury to persons or loss of property arising out of the undersigned00 use of any equipment rented hereunder.I have read and understand the 00ental / Trail Offer Program Agreement00and agree to the terms listed therein.
Signed:________________________________________Dated:_________________________________
RETURN POLICY
In the event a customer requests a return a product to South Florida Mobility, Inc. the following will apply:
: A 25% restocking fee may be imposed, depending on: The Extent of usage, any damage incurred,
length of time used, circumstances of return.
: Third party payers will be notified of return and any refund due will be due to the third party payer in direct relationship
to the original purchase.
: South Florida Mobility, Inc. reserves the right NOT to accept a returned product for any reason after 30 days.
: Some items and components may not be returnable, those include: Any special order product, any upholstered item,
any seat cushion, any item altered from it00 original state without written authorization from South Florida Mobility, Inc.,
Batteries, Electronic Components
: A cleaning fee may be imposed at the discretion of South Florida Mobility, Inc..
: Freight cost is not refundable.
I have read and understand the 00eturn Policy00and agree to the terms listed therein.
Signed:__________________________________________________ Dated:_________________
