EQUIPMENT RENTAL AGREEMENT - Global Polygraph Network by yaosaigeng


									                   EQUIPMENT RENTAL AGREEMENT
Customer Name:

Customer Address:

Contact Name and Phone number(s):

The above-named customer agrees to rent from Global Polygraph Network (GPN) one Stoelting
Polyscribe polygraph instrument (unit). The fee for this rental is $200.00 per day or $1000.00 per
week, whichever is less, plus all shipping costs. There will be a minimum charge of two-day rental
($400.00), which will be charged upon receipt of this request. Rental begins on the date the unit is
received at the below-address and ends on the date the unit is shipped back. The unit must be shipped
insured for $3,000. with tracking available. The unit will be accompanied by operating instructions
which the customer agrees to read and follow. The customer agrees to be responsible for any damage
caused to the polygraph by anyone’s failure to follow the included operating instructions during the
rental period. If customer does not pick up unit him/herself, GPN will ship so that unit arrives as close
to the "needed by" date as possible, but GPN can not guarantee an exact delivery date. Customer
understands that while the rental unit will appear to be a functioning polygraph, one or more
components may not be operational, and the unit will not be used as a diagnostic tool to determine
truthfulness of an individual. GPN rents this unit for demonstration, simulation and entertainment
purposes only. This unit will not be operated or handled by anyone under age 18. Cardholder agrees
to all charges as outlined above. Long-term rentals will be charged weekly.

Date needed by:                                              How long needed:

Shipping address:

Phone:                                              Email:

Credit or Debit card number:

Exp. Date:                                  Card CVV security code:

Credit card billing name, address and phone if different than customer information:

Signature of customer:

Signature of cardholder:

Date submitted:

         FAX this signed document to Global Polygraph Network at 570.223.1514

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