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  1. These Terms and Conditions, the rental document signed by you, and a return record with computed rental charges together constitute the rental agreement between you and SURE HEALTH MEDICAL SUPPLIES.
  1. I rent from you the equipment described on the rental document and I agree to its terms and to the terms below and on the other panels of this rental document provided any such term is not prohibited by the law of a jurisdiction covering this rental in which case such law controls. I, Me and my refer to the person who signs and is mentioned on this agreement, you and your refers to SURE HEALTH MEDICAL SUPPLIES. 
  1. Where I’ll Return the Equipment. The equipment will be returned to the agreed return location named on the rental document. A rate change or special charges may apply if returned to a different location. I will pay for any and all charges of getting the equipment returned to your location when I return the equipment to a different location than I have agreed to on this rental document.
  1. Damage/Loss To The Equipment. I owe for all loss or damage due to the equipment regardless of fault (unless ordinary negligence is prohibited by law.) Whether due to collision, vandalism or any other cause except accidental fire or explosion, or natural causes. If the equipment is stolen or damaged, I’ll pay its retail fair market value before theft or damage less salvage, unless SURE HEALTH MEDICAL SUPPLIES repair costs plus the diminution of the equipment’s value after repairs is less and you are not required by law to salvage the equipment, in which case I’ll pay the latter amount. I’ll also pay loss of use based on reasonable downtime o r a specified by law. Plus a reasonable administrative fee determined by you or specified by law (except for the theft where the equipment is not recovered). All of which are also part of the “loss”. I’m responsible for the loss if I or an additional user authorized or not 1) abuse the equipment or violate prohibited use or operation; 2) operate equipment recklessly or while under the influence of alcohol or a controlled substance 3) fail to promptly report an accident to police and SURE HEALTH MEDICAL SUPPLIES 4) fail to complete an accident report; 5) obtained the equipment through fraud or misrepresentation; or 6) use the equipment for an illegal purpose. If my responsibility for loss or damage is covered by my own insurance or my charge card issuer, I will identify my insurer and pol icy number or card issuer and its insurer. I authorize you to collect the loss directly from the insurer. I authorize you to collect the loss from a third party responsible for the damage. You will refund any sum you collect above the loss.
  1. Prohibited Use of the Equipment. I will not use or permit the equipment to be used in a manner that is not consistent with its original design. I acknowledge that I have been properly instructed in the use of rented equipment. A violation of this paragraph automatically terminates my rental, makes me liable to you for all the penalties, fines, forfeitures, liens and recovery and storage costs, including all related legal expenses.
  1. Indemnification. I agree to indemnify you for any loss, liability and expense that you incur arising out of the use of the equipment which results from any unauthorized use or prohibited operation of the equipment. In consideration for the acceptance of this contract made the date herein stated by the aforementioned, I understand and agree that except in the event of SURE HEALTH MEDICAL SUPPLIES’ gross negligence, I accept full responsibility for bodily injury, property damage, death, medical and other financial loss expenses to include, but not limited to, the time lost from school or work or disability, which are sustained by any administrators, and assigns, do hereby release and discharge SURE HEALTH MEDICAL SUPPLIES, and its respective servants, agents, officers and all other participants of and from all claims, demands, actions and causes of action for same injuries, damages and death and also for bodily injury and/or property damage, and to death of others which you may cause should you not act in a prudent and cautious manner at all times. I further agree to indemnify SURE HEALTH MEDICAL SUPPLIES Supply for any and all costs including reasonable attorney's fees, incurred in defending against any claims. Only the persons named above may use the equipment. I have read the rules, which form this contract, and agree to abide by them.
  1. Repossessing The Equipment. You can repossess the equipment anytime it is found being used in violation of the law or the terms of this agreement, or appears to be abandoned. You can also repossess anytime you discover I made a misrepresentation to obtain the equipment. You need not notify me in advance.
  1. Collections. All charges, fees, and expenses, including payment for loss of or damage to the equipment, are due at your demand. If I do not pay all charges when due, I agree to pay a late charge of 1 ½ per month, or as permitted by law on the past due balance. I will pay any collection costs, including a service charge for any check which is not honored by a financial institution and your reasonable attorney’s fees. If I don’t pay any amount when due, if the law permits, you may contact me or my employer at my place of business about payment.
  1. Charge Card Reserve. I have been informed that my credit information will be held on file, until equipment is returned. 
  1. Property left in/on the Equipment. You are not responsible for loss of or damage to any property left in or on the equipment, on your premises, or received or handled by you, regardless of who is at fault. I’ll be responsible to you for claims by others for loss or damage. 
  1. Late Charges: It is the renter’s responsibility to contact SURE HEALTH MEDICAL SUPPLIES 48 hours prior to pick up date. Late charge per day will be based on the daily rental of item.

I Agree to Terms of Rental Agreement


Name: _________________________________________________________


Signature:  _____________________________ Date: ____________________



Product Weekly Charge Monthly Charge
Manual Wheel Chair 18”-20” $40 $120
Manual Wheel Chair 22”-24” $45 $150
Elevating Leg Rest * Each $10 $40
Reclining Wheel Chair $100 $200
Transport Chair $40 $120
Hospital Bed Semi-Electric w/Rails $75 $200
Hospital Bed Full-Electric w/Rails $85 $250
Hospital Bed – Bariatric w/Rails $100 $260
Lift Chair 19” – 20” $75 $200
Lift Chair 22” and Wider $100 $300
Medium Size Scooter $100 $300
LG/XLG Size Scooter $125 $350
Motorized Wheel Chair $125 $350
Motorized Wheel Chair - Bariatric $150 $375
Knee Caddy $45 $120
Rollator – Walker w/Wheels and Seat $35 $110
Hoyer lift $50 $145