1. The objective of the REMís Rent - Loan Ė Trial Program is to loan-out high quality durable medical equipment to assist in decision making, to serve as a loaner while the consumer is waiting for device repair or funding, to provide an accommodation on a short term basis for a time-limited event, or for training, self-education or other personal development activities.
2. Rental equipment is limited, and therefore may only be reserved up to 24 hours in advance.
3. Equipment may be rented for up to two weeks. A new agreement form must be signed if a longer rental period is approved. Payment in full is due at time of reservation. The REM reserves the right to review all requests for rentals and may at its discretion allow or deny the request.
4. All equipment should be picked up and returned to our Concord Office. If REM delivery or pick-up is requested, the following standard REM fees will be charged each trip. Exact delivery time will subject to the REMís schedule. These charges must be paid at time of rental and apply with no exceptions:
∑ $50.00 fee 0 to 10 mile trip from our office as determined by MapQuest or similar program.
∑ $100.00 fee 10 miles to 50 miles from our office as determined by MapQuest or similar program.
∑ $100.00 plus $2.00 per mile above 50 miles from our office as determined by MapQuest or similar program.
5. All rented equipment requires a credit card for payment. A Rate of $25 per day will be assessed for each 24 hour period the item is late up to 7 days, at which time the full purchase price listed below will be charged in addition to any rental fees paid.
6. Rental payments CANNOT be used as down payments or credit towards a purchase regardless of the amount of payments made. The Renter is fully responsible for the return and condition of the equipment. Any damage or repairs are solely the responsibility of the Renter, and will be charged to the credit card on file.
7. Rental / Loan / Trial RATES:
a. One Day $25.00 Pick-up Monday-Thursday between the hours of 8:00am and 4:30pm, and return before 4:30pm the following day.
b. Two Days $50.00 Pick-up Monday-Wednesday between the hours of 8:00am and 4:30pm, and return before 4:30pm two days later.
c. Weekend Special $55.00 Pick-up Friday between the hours of 8:00am and 4:30pm, and return before NOON the following Monday.
d. One Week $75.00 Pick-up Monday-Friday between the hours of 8:00am and 4:30pm, and return before 4:30pm the same weekday of the following week.
e. Two Weeks $125.00 Pick-up Monday-Friday between the hours of 8:00am and 4:30pm, and return before 4:30pm the same weekday two weeks later.
RENTER EMAIL _________________________________________________________________________
RENTAL PERIOD___________ RATE $ _______________RETAIL PRICE $______________________
DELIVERY FEE (If Any) $___________________________PICK-UP FEE $________________________
PICK-UP DATE____________________________________PICK-UP TIME________________AM / PM
RETURN DATE____________________________________RETURN TIME________________AM / PM
understand and agree to the rules and policies of this 2-page REM RENT-LOAN-TRIAL Policy Agreement. I agree to return the item by the date and time listed. I understand and authorize my credit card to be charged an additional $25 late fee each day the equipment is not returned; up to seven days, at which time I will then be charged the full retail price of the equipment listed above (minus the late fees assessed). I understand and agree I am solely responsible to return the equipment in the same condition it was received or I will be charged for cleaning, repair or replacement of the equipment up to the full retail price listed above.
Approved By REM Staff ___________________________________________Date:____________________