HOLTER PACKAGE RENTAL AGREEMENT
Equipment Owner:Paula and/or Jeff Vandervoort
Street Address:24276 Hardage Ct, Porter, TX 77365
Telephone:(713) 283-7557
Email:
Renter's Name: ______Preferred Reservation Dates:______
Street Address: ______Second Choice Dates:______
Telephone #: ______
Email:______
EQUIPMENT RENTED: Alba Digital Holter Monitor Serial #18416
Monitor Cover, SD Cards
DogLeggs Vest with Belt – size Medium OR
DogLeggs Vest with Belt – size Medium/Large
RENTAL TERMS AND CONDITIONS:
Fees: All fees are due in advance in United States Dollars, made out to above-named holter owner. Personal checks are not allowed for payment.
Rental fee: $75.00 for ten (10) days is payable prior to delivery of equipment; rental term begins on date of OWNER's shipment and ends upon OWNER's receipt of returned equipment. Rental includes the use of the monitor, case, vests, leads and one Hook-Up kit. Hook-Up kit does not need to be returned to OWNER. Unused hookup kits or electrodes are not refundable.
Additional Hook-Up kits are available for $ 22.00 each (or current price listed in store), in addition to stated rental fee. One Hook-Up kit is required per dog.
Additional electrodes are available for $4.00 each (or current price listed in store). OWNER advises purchase of at least one or two extra electrodes to cover potential mistakes in hook-up protocol.
Rental fee does not include shipping charges. Shipping is charged separately. Prices vary depending on choice of shipper by Renter.
A deposit of $400.00 is necessary to be returned only upon receipt subject only to damage, loss or late fees.
Reading of the report is NOT INCLUDED with the rental and must be separately secured by RENTER. This is typically available by Alba Medical. Current cost is $30.00 for interpretation by technician. If an additional overread is desired by a cardiologist, Alba offers that service for an additional fee.
No allowance will be made for any rented equipment or portion thereof claimed as unused. Acceptance of returned equipment by OWNER does not constitute a waiver of any of the rights OWNER has under the rental agreement.
Equipment Delivery and Return:
The equipment shall be delivered to RENTER and returned to OWNER at RENTER's risk, cost and expense, using USPS PRIORITY MAIL, DELIVERY CONFIRMATION and including $1500.00 INSURANCE. Rental fee is due for the full term, even if the equipment is returned before the end of the term. If the equipment is not returned by the end of the term late charges shall accrue at $ 20.00 USD per day and are due immediately.
Equipment Damage:
RENTER shall take all due care to protect equipment from damage due to any cause including but not limited to other animals, inclement weather or shipping. RENTER has 24 hours to notify OWNER or USPS of damage upon receipt of equipment.
Vest, case and belt shall be returned clean and sticky-rolled for dog hair. (Vest may be washed in cold water by itself on delicate cycle and IS NOT TO BE PUT INTO A DRYER.) Lead wires are to be gently wiped clean of tape residue with alcohol wipes prior to return.
RENTER shall pay OWNER full compensation for replacement and/or repair of any equipment not returned because of loss, or any equipment damaged and requiring repair. Equipment returned dirty, sticky or damaged will be assessed an appropriate fee to return equipment to condition in which received. A written estimate or invoice for replacement/repair is conclusive as to the amount RENTER shall pay under this paragraph, same currently being $1700 for monitor replacement and $75 for lead replacement. Holter vests are currently $150. However, replacement charge may have changed since this contract was written; therefore replacement will be charged at current retail pricing. Rental late fee of $20/day shall be assessed until equipment is in full working condition and available for rental again.
Equipment Location:
RENTER shall not remove the equipment from the address of RENTER or the location shown herein as the place of use of the equipment without prior written approval of OWNER. RENTER shall inform OWNER upon demand of the exact location of the equipment while in RENTER's possession.
RENTER shall allow OWNER to enter RENTER's premises where the rented equipment is stored or used at all reasonable times to locate and inspect the state and condition of the rented equipment. If RENTER is in default of any of the terms and conditions of this agreement, OWNER and his agents, at RENTER's risk, cost and expense may at any time enter RENTER's premises where the rented equipment is stored or used at any time and recover the rented equipment.
RENTER shall not pledge or encumber the rented equipment in any way. OWNER may terminate this agreement immediately upon the failure of RENTER to make rental payments, or upon RENTER's filling for protection from creditors in any jurisdiction.
Warranty:
OWNER makes no warranty of any kind regarding the rented equipment. RENTER shall indemnify and hold OWNER harmless for all injuries or damage of any kind for repossession and for all consequential and special damages for any claimed breach of warranty.
Attorney Fees:
RENTER shall pay all reasonable attorney and other fees, expenses and costs incurred by OWNER in protection his/her rights under this rental agreement and for any action taken by OWNER to collect any amounts due under this rental agreement.
Complete Agreement:
This writing constitutes all agreements between OWNER and RENTER(S). By signing this agreement, RENTER signifies complete understanding and agreement of all above described terms and conditions. All disputes shall be settled within the jurisdiction of OWNER.
OWNER:RENTER:
______
Paula F. or Jeffrey R. VandervoortPrinted Name: ______
Date:______Date:______
Credit Card Info (Card will be charged only in the event of damage
Card #______
Expiration Date:______Code:______
Holter Kit Description
(Return all parts after using)
1 digital Alba Monitorwith 5 leads attached
1 Custom monitor case
1 size ML DogLeggs BreathePrene Silvertec K9 Holter Vest with Velcro closure and Belt OR
1 size M DogLeggs BreathePrene Silvertec K9 Security Belt with Velcro closure and Belt
Hookup Instruction Sheets
Equipment Instruction Sheets
1-3 SD Cards
Equipment box with handle
Hook-Up Kit Description
(Keep or discard these parts after using)
5 Electrodes
1 roll Coban/Vetrap or equivalent self-adherent wrap
1 roll Elastikon or equivalent tape
2 Alcohol Wipes
Battery
1 Patient Diary
1