Please complete this rental form/Agreement. Upon completion, you will receive an email or phone call to collect payment and discuss delivery of your battery. Thank you!

Contact Information

Name*

Billing Address*

City*

State*

Postcode / Zip*

Ship To Address*

City*

State*

Postcode / Zip*

Email*

Phone #*

Home #

Select Products to lease*

EXP48PRO - $59.00 per week (2 week min)

EXP96PRO - $79.00 per week (2 week min)

EXP48PRO with 60 Watt Solar Panel - $79.00 per week (2 week min)

EXP96PRO with 60 Watt Panel - $99.00 per week (2 week min)

Additional EXP48PRO - $50.00

Additional EXP96PRO - $70.00

Please enter the date you want to start using the equipment

Please enter the date you want to stop using the equipment (2 week minimum)

TERMS & CONDITIONS OF WESTERN MEDICAL / EXP PRO RENTAL AGREEMENT (CPAP BATTERIES)

PAYMENT - Prior to shipping of the equipment, the Lessee shall be required to pay a deposit equal to the retail price of the equipment plus a $20.00 shipping fee. The difference of this amount less the accrued rental fee for the time used will be refunded back to the card once the equipment received back to EXP PRO. A receipt will be emailed which will show the total rental charges.

SHIPPING & FREIGHT - EXP PRO will need at least 10 business days prior to the need of the equipment to allow shipping time and a few days for you to check out/test the equipment. We test all equipment prior to shipping.

Shipping is $20.00 and covers both directions. A return label will be included with the battery for return shipment. All equipment, cords, manuals and original box must be sent back. Please also send back in the original shipping box (has labeling).

RENTAL PERIOD - The rental period doesn't start until your requested star date and ends the day it is sent back (2 week minimum) using the return label that will be included in the original box. Please notify EXP PRO if additional days are needed, the refund to the credit card will be prorated and deducted from the credit back to the credit card based on number of days of extra use. If FEDEX does not receive your equipment by the end date and we are not notified, you will be charged for each additional day (prorated) until it is received by FEDEX.

ACCEPTANCE OF EQUIPMENT - The Lessee shall inspect each item and part of the Equipment upon delivery and pursuant to this Agreement. The Lessee shall have twenty-four (24) hours from the delivery date to inform the Lessor of any discrepancies. If for any reason the Lessee claims the Equipment was not the same as described under this Agreement, the Lessee shall be able to return the Equipment and obtain a full refund for any Rent, Deposit, and any other payments made.

RISK OF LOSS OR DAMAGE: The Lessee assumes all risk of loss or damage to the Equipment from any cause and agrees to return it to the Lessor in the condition received, with the exception of wear and tear, unless otherwise provided in this Agreement.

Rental Rates - The prices below include the specific CPAP DC power cord you need to power your CPAP machine from the battery.

EXP48PRO: $59 per week
EXP96PRO: $79 per week

EXP48PRO with 60 watt solar panel: $79 per week
EXP96PRO with 60 watt solar panel: $99 per week

Each additional 48PRO: $50 per week

Each additional 96PRO: $70 per week

Signature

E-Signature Confirmation

The listed information is herewith submitted for the purpose of opening an account and I do certify that the information contained in this form is accurate and complete.

By signing, you are agreeing to terms & conditions, policies, rental rate and warranties contained in this form.

I, the applicant for this agreement, warrant the truthfulness of the information provided in this application.

Electronic Signature*

E Signature*

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Date*