Rental Form

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					                                Rental Form

Name___________________________________________Renting for____________________
Address_______________________________________________________________________
City_______________________________________State_______Zip_____________________
Phone Number______________________Driver’s 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____________________

Quantity           Item Description of Rental                Rate          Total




                                                            Total Rental
                                                            Tax
                                                            Delivery
                                                            Contract Total
                                                            Amount Paid
                                                            Balance Due

                                                            Cleaning/Repairs
                                                            Additional
                                                            Charges


Please Read Before Signing
1. Rentals are payable in advance.
2. A charge will be added for items requiring cleaning or repair upon return.
3. You are charged for time equipment is in your posession.
4. Read back of form which describes all rental terms and conditions.

Signature X________________________________________ Date___________________
                RENTAL / TRIAL OFFER PROGRAM
               CONTRACT – TERMS AND CONDITIONS
South 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:

1.   The undersigned certifies and acknowledges that he has on date and time specified, received the equipment identified in this
     contract.

2.   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.

3.   The undersigned, if the equipment is lost or damaged, will pay South Florida Mobility, Inc. the cost of replacement or repair of
     the equipment.

4.   The undersigned has personally inspected the equipment and found it to be in good working condition.

5.   The undersigned will immediately discontinue use of the equipment should it at any time, while in The undersigned’s
     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.

6.   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.

7.   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.

8.   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 “Date Due In Without Additional Charges” section of the contract, or before that date if conditions and
     circumstances indicate has occurred.

9.   The undersigned will pay all collection fees, court costs, attorney’s fees, and/or any other expenses required to enforce this
     contract.

10. “SAVE HARMLESS”: 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 undersigned’s use of any equipment rented hereunder.

I have read and understand the “Rental / Trail Offer Program Agreement” and 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 it’s 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 “Return Policy” and agree to the terms listed therein.

Signed:__________________________________________________ Dated:_________________

				
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