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Rental Form

  • Customer Information

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  • Rental Information

    • Dates

  • Rental Terms and Conditions:

    1. This is a transaction of a lease only, the equipment is accepted in its “as is” condition (having been inspected by the undersigned upon receipt).

    2. The customer agrees that the company is not the manufacturer of the equipment and is therefore not responsible for its adequacy or for any defects in the equipment.

    3. Advanced Mobility & Medical Depot does not prescribe any such equipment and makes no representation with regards to the suitability of the equipment for any purpose of the customer.

    4. Any technical issue or malfunction of the rental equipment has to be reported to Advanced Mobility & Medical Depot by the renter or his/her representative ASAP.

    5. Advanced Mobility & Medical Depot will not leave any rented durable medical equipment (DME) requiring charging if after an on-site evaluation it is determined there are electrical safety issues

    6. The renter is responsible for any damage or loss of the rental equipment and gives the right to Advanced Mobility & Medical Depot to charge the cost of repair or the whole list price of the equipment in case of loss.

    7. The rental equipment has to be used in the proper way by the renter only. The renter will not allow the equipment to be used or played with by the others, especially children.

    8. The rental equipment has to be kept in a dry and clean place when not in use.

    9. The rental mobility products should not be used under the rain or on slippery surfaces.

    10. The client is responsible for any injury or damage caused by negligence, misuse, accident or abuse of the equipment.

    11. The renter hereby gives authorization to charge the on-file credit card for any due rental charge, repair cost of damaged equipment or the total cost for lost equipment.

    12. The late payment fee is $20 per day

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