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  • Rental and Sales Terms of Agreement

Rental and Sales Terms of Agreement

 

1. I understand and agree that I am responsible for ALL rental fees and other charges for equipment or services that are not covered by Medicare. Medicaid or other medical insurance programs or plans, public or private, under which I am entitled to benefits. I agree to provide to The Company all documents and other information necessary for The Company to obtain direct payment from such third party payors. I agree to pay all deductible amounts and other charges not covered by the assignment of benefits. I also agree to pay The Company for all collection fees, attorney’s fees, court costs and other expenses involved in collecting ant charges hereunder.


2. I agree that all rentals are on a monthly basis and that if I wish to extend the rental of the equipment beyond the initial month. I agree to make payment for the following month on or before the due date, either at the store or by mail. If the item is not returned by the monthly due date, I agree to continue the rental for an additional month and the rental charge will be due and payable immediately by me.


3. It is agreed that the title of rental remains with The Company and that I will return all rented items immediately upon expiration of the rental period. I agree that all items have been delivered in good condition and that I am responsible for normal care of the equipment (including parts and accessories) and I agree to pay in full for any loss or damage due to accident, fire, flood, theft, wind damage or negligence at the current fair market value.


4. Except with the express written consent of The Company and that I will return property will be used solely by me, only at the address designated and solely for the for the purpose for which the property was manufactured and intended.


5. I agree to hold harmless, defend and indemnify The Company against any and all liability, loss or expense whatsoever resulting from negligent or improper use of the property.


6. I agree to immediately cease using any rented property if it becomes unsafe or in disrepair. I will immediately notify The Company in either case, and The Company agrees to replace the rented property with similar property in good working condition with reasonable dispatch. In such case, I agree to be responsible for any repair or replacement caused by my act or neglect.


7. I acknowledge that The Company is not the manufacturer of the equipment of the manufacturer’s agent and that the company makes no express or implied warranty of any kind whatsoever with respect to the equipment, all of which are hereby expressly disclaimed, including but not limited to: the merchantability of the equipment of its fitness for any particular purpose, the design or condition of the equipment; the quality or capacity of the equipment; compliance of of the equipment with requirements of any law, rule, specification or contracts thereto; patent infringement; or latent defects.


8. I acknowledge that this assignment applies to rental of the medical equipment, sales and services listed on the reverse side of this agreement and that administrative expenses beyond normal billing procedures may be subject to additional charges not covered by third party payors.


9. I am aware that the need for this equipment is prescribed by my physician and neither The Company nor the manufacturer is responsible for the effectiveness of the equipment or the success or failure of any treatment performed with the equipment.


10. This agreement contains the entire agreement of the parties and supersedes any other discussions of agreements relating to the subject of this agreement. The customer acknowledges that he has not received any representations or promises concerning the property or the terms of this agreement other than as set forth herein.


11. This agreement may not be assigned by the customer without the prior written consent of The Company. The Company may assign this agreement to any successor to The Company’s business. This agreement may be amended or modified only in writing signed by both parties.


12. WARNING: The Company retains title and full ownership rights to the property rented hereunder. By execution of this agreement, the customer acknowledges and understands that if the property is not returned to The Company as provided herein, The Company will institute legal proceedings against the customer to recover the property and any and all damages which The Company may suffer related to the customer’s failure to return the property in good condition and repair.


13. Billings Clinic. H.O.M.E. (1) will fill orders from its own inventory or inventory of other companies with which it has contracts to fill such orders; or fabricates or fits items for sale from supplies it buys under contract; (2) is responsible to oversee delivery of items that the supplier ordered for the beneficiary. The supplier is also responsible to assure delivery of large items to beneficiary. (3) honors manufacturer’s warranty on all items sold or rented; (4) will answer questions or complaints a beneficiary has about an item or use of an item that is sold or rented to the beneficiary. If the beneficiary has questions about MEDICARE, the supplier will refer the beneficiary to the appropriate carrier; (5) maintains and repairs directly, or through a service contract with another Company, items it rents to a beneficiary (6) accepts returns of substandard (less than the full quality for a particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and/or sold) from the beneficiary; (7) discloses consumer information to each Medicare customer. This consists of a copy of these supplier standards to which it must conform; (8) complies with the disclosure provisions in Title XI of the Social Security Act, section 1124A(a).


14. SALES RETURNS: Returns of purchased items will be accepted only in unopened packages and/or in new and saleable condition within fourteen (14) days from the date of purchase with sales receipt. No merchandise may be returned if used next to the skin or used for personal care purposes (i.e. commodes, sitz baths, etc.). Special order items may require a deposit and are non-refundable and nonreturnable regardless of circumstances.

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