MEDICAL EQUIPMENT RENTAL TERMS & AGREEMENT

MEDICAL EQUIPMENT RENTAL TERMS & AGREEMENT:

I,________________, (“RENTER”) must be a major credit card holder, sign this medical equipment rental agreement and submit a valid government or state identification. ANTILLES SPECIALTY MEDICAL SOFLO LLC (ASMED), a Florida Limited Liability Company, rents to the renter signing this medical equipment rental form and holds the subject responsible to all the terms and conditions set forth in this rental agreement. The renter or the person representing the renter understands that they are fully responsible for all the terms and conditions set forth in this medical rental agreement:
1. The medical equipment is the property of ANTILLES SPECIALTY MEDICAL SOFLO LLC, and is in good standing condition. Renter shall return equipment in the same condition as when received by ANTILLES SPECIALTY MEDICAL SOFLO LLC. I (RENTER) or the person I am representing hereby agrees to take sole responsibility for any damages outside of normal wear and tear of the medical equipment and agree to be responsible for all accessories including but not limited to battery charger, basket and key. All accessory items are due upon the return of
equipment.

2. If the renter cancels the rental agreement (3) three days before the rental start date, will receive 100% refund of the amount paid. Cancellations made less than 3 days in advance will be eligible for a 50% refund. If you return the equipment before the end of the rental period, no partial refunds will be provided ANTILLES SPECIALTY MEDICAL SOFLO LLC, its agents and affiliates should they prevail in
connection to litigation shall be entitled to recover costs including attorney fees associated with all proceedings.

3. ANTILLES SPECIALTY MEDICAL SOFLO LLC, shall not be liable or responsible for the loss of or damage to any property left unattended, lost, damaged, stolen, stored or transported by Renter. Renter assumes all responsibility regarding loss and damage. Renter agrees to waive all claims against ANTILLES SPECIALTY MEDICAL SOFLO LLC, affiliates, agents and employees by reason thereof and renter agrees to hold ANTILLES SPECIALTY MEDICAL SOFLO LLC harmless from and to defend and Indemnify ANTILLES SPECIALTY MEDICAL SOFLO LLC against all claims based upon or arising out of such loss and damage.

4. Renter assumes all risk and liability for any loss, damage, or injury, including death, to persons or property of Renter or others arising out of the use, operation of driving of the medical equipment.

5. The additional conditions outlined above have been reviewed and accepted as part of this agreement.

6. Renter is responsible for the medical equipment and will reimburse ANTILLES SPECIALTY MEDICAL SOFLO LLC Legal Owner of Medical equipment, for the full Replacement cost upon demand for any damage, loss, theft or destruction of the medical equipment. The Renter understands and authorizes that ANTILLES SPECIALTY MEDICAL SOFLO LLC will charge the Credit Card Used for any repair costs or replacement costs of the medical equipment deemed necessary.

7. The following restrictions are cumulative and each shall apply to every use, operation of the medical equipment. Under no circumstances shall the medical equipment be used, operated by person: a)under the age of 18;or b) while under the influence of intoxicants or narcotics; or C) in an unsafe manner.

8. Renter shall defend, indemnify and hold harmless ANTILLES SPECIALTY MEDICAL SOFLO LLC, its agents, affiliates, officers, and employees from and against any and all losses, liability claims, damages, injuries, demands, actions and causes of whatsoever, arising out of or related to any loss, damages or injury claimed by persons that may arise from the use, operation or driving of the medical equipment.

9. Renter assumes all costs and expenses of every kind and nature, including legal fees and disbursement arising out of and in connection with the use, operation or driving of the medical equipment.

10. ANTILLES SPECIALTY MEDICAL SOFLO LLC assumes NO LIABILITY or responsibility for any acts or omissions of Renter or of Renter agent , servants, affiliates or employees.

11. Renter shall notify ANTILLES SPECIALTY MEDICAL SOFLO LLC immediately of any and all accidents and damage resulting from the use, operation or driving of the Medical equipment.

12. Renter shall drive, operate the equipment with reasonable care and diligence according to manufacturer guidelines and comply with the terms of this agreement. Under no circumstances is a scooter to be used on sand, dirt, or grass. Electronic medical equipment should not be exposed to rain or other environmental factors that may cause damage during use. Negligence of equipment will result in renter being liable for all repair costs.

13. Renter agrees to pay all costs, expenses, and attorney’s fees incurred by ANTILLES SPECIALTY MEDICAL SOFLO LLC in collecting sums due or in regaining possession of medical equipment or in enforcing or recovering any damage, losses or claims against Renter.

14. Renter or the driver of the medical equipment shall in no event be deemed the agent or employee of ANTILLES SPECIALTY MEDICAL SOFLO LLC in any manner or for any purpose whatsoever.

15. Any individual executing this Agreement as Renter in a representative capacity shall be bound personally, jointly and severally, with such fiduciary,corporation or other entity as to all obligations, expressed or implied, arising hereunder.

16.This Agreement shall be binding upon the distributees, heirs, next of kin, executors, administrators and personal representatives of the undersigned Renter.

17.We reserve the right to refuse renting to anyone if deemed necessary due to various reasons. 

Waiver of Liability Hold Harmless Agreement:

I or the person I am representing understands, I or the person I am representing is fully responsible for the equipment during the rental period and any damage or loss incurred while in my possession. I or the person I am representing guarantee that I have provided accurate information to assure that I or the person I am representing has rented the proper equipment and fully understand how to use it in the proper manner. I authorize ANTILLES SPECIALTY MEDICAL SOFLO LLC, d.b.a. ASMED, to charge my credit card for and damages or extra charges accrued during my rental agreement. I or the person I am representing hereby fully release, waive, and discharge the right to seek any medical reimbursement or the legal prosecution of ANTILLES SPECIALTY MEDICAL SOFLO LLC d.b.a. ASMED and or any
owners or employees for any physical injury resulting or property damage from the use of the rental equipment provided by ANTILLES SPECIALTY MEDICAL SOFLO LLC d.b.a. ASMED. I or the person I am representing agree to be the sole person using the equipment and I or the person I am representing are fully responsible for any person/s who, with or without my consent, sit on, stand, ride, lift or use the equipment and I or the person I am representing hereby indemnify ANTILLES SPECIALTY MEDICAL SOFLO LLC d.b.a. ASMED for any legal prosecution from physical injury resulting to myself or someone else or property damage from
the rental equipment provided by ANTILLES SPECIALTY MEDICAL SOFLO LLC d.b.a. ASMED. It is my express intent that this Release and Hold Harmless Agreement shall bind my family if I or the person I am representing is alive and my heirs, assigns and personal representative if I am deceased. It shall be deemed as a release, waiver, discharge, and covenant not to sue ANTILLES SPECIALTY MEDICAL SOFLO LLC d.b.a ASMED, independent contractors, officers, agents, employees, and affiliates. Person below Acknowledges receipt of Medical Equipment Rental Terms, and Waiver of Liability Hold Harmless Agreement and agrees to the obligations set forth by the agreement with the issuer.

Print First & Last
Name:________________________________________________________________
Signature:__________________________________________________ Date:___/____/___
Assigned Equipment #:_________________
Additional Equipment Notes:_____________________________