Colbrow Medics Equipment Hire Agreement

Colbrow Medics Equipment Hire Agreement
Contact Details
Name *

First Name Last Name
Email *
example@example.com
Contact Phone (Business Hours) *
Invoicing Organisation *
Invoicing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Hire Start Date *

Day Month Year
Date
Hire End Date *

Month Day Year
Date
Equipment Details
Item #1 *
Item #2
Item #3
Item #4
Delivery
Please note that a deliveries are made during business hours and there must be a person available and the location to sign for the delivery
Requested Delivery Date *

Month Day Year
Date
Equipment Delivery Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Delivery or Pickup Contact Person *

First Name Last Name
Delivery or Pickup Contact Person Phone Number *
Delivery or Pickup Notes
Terms & Conditions
Please review the Colbrow Medics Terms and Conditions prior to submitting a booking
Do you agree to the Colbrow Medics Terms and Conditions? *

Yes I have read and agree to the Terms and Conditison
Pre-payment or Government Purchase Order is required prior to release of hire equipment *

Yes I understand
A refundable security bond is required prior to release of the hire equipment *

Yes I understand
Should be Empty:

Contact Details