equipment rental form - static1.squarespace.comrental+form.pdf · all equipment rental availability...
TRANSCRIPT
7261 S Broadway Suite 12L
Littleton CO, 80122 (720) 639-2623 www.3cpr.org
EQUIPMENT RENTAL FORM
To reserve equipment for rental, please contact Tim Snyder, Colorado Cardiac Owner, by emailing this form to Colorado Cardiac CPR and First Aid Training at - [email protected] or call us at 720-639-2623
ALL EQUIPMENT RENTAL AVAILABILITY IS BASED ON COLORADO CARDIAC CLASS SCHEDULE THEN ON A FIRST COME FIRST SERVE BASIS.
Business Name Contact Name
Business Address City, State, Zip
Phone/Cell Email Address
Class Date: # of Students expected
Expected Pick-up Date and Tim Expected Return Date and Time
RENTAL TERMS AND CONDITIONS
RENTER hereby agrees as follows:
1. RENTER shall keep the equipment in a good state of repair and is responsible for any damage to, loss, or theft of the equipment occurred during the rental period.
2. RENTER shall pay Colorado Cardiac CPR full compensation for replacement and/or repair of any equipment that
may be damaged, lost, or stolen during the Rental Period. The price listed under purchase price is the full replacement cost minus shipping.
3. RENTER is not permitted to move or use any equipment rented from Colorado Cardiac CPR at a new location
unless granted written consent from Colorado Cardiac CPR.
4. RENTER is responsible for pickup and return of rented equipment.
5. RENTER will pay for the rental equipment when equipment is picked up. Payment will include a returnable deposit of $150.00.
6. RENTER is responsible for checking equipment quantity, functionality, and condition prior to picking up equipment. If equipment malfunctions RENTER must return equipment for replacement.
7. Colorado Cardiac CPR is not responsible for any injuries or damage due to the use of equipment.
8. RENTER is responsible for all legal fees and costs incurred by Colorado Cardiac CPR in regards to collecting any
balance due.
9. Colorado Cardiac CPR requires at least 14 days notice to guarantee equipment availability.
10. By signing this the RENTER agrees to the terms stated above.
Renter Name: _____________________________________ Renter Signature: ____________________________________ Date: _______________________
EQUIPMENT RENTAL PRICING (per AHA 1 CPR manikin to every 3 students) Amount
Requested DESCRIPTION
OF EQUIPMENT Purchase
Price Rental Price
Amount Out In
# Verified By # Verified By
Adult ________
Infant ________
CPR Manikin
Adult $135
Infant $122
$10
Adult ________
Child ________
Infant ________
ALS Intubatable Manikin
Adult $2,215
Child $1,795
Infant $1,795
$40
Adult ________
Infant ________
Ambu Bag
$20 $2
Adult ________
Infant ________
Pocket Mask
$3 $1
Training AED $400 $10 Oropharyngeal
Airways (Set of 5 assorted
sizes)
$10 $5
Advanced Airway (Circle one)
I-Gel King Tube
LMA ET Tube
$20 $5
EQUIPMENT RENTAL PRICING (per AHA 1 CPR manikin to every 3 students)
Amount Requested
DESCRIPTION OF EQUIPMENT
Purchase Price
Rental Price
Amount Out In
# Verified By # Verified By Heartsaver CPR/AED
DVD $100 $10
Heartsaver First Aid DVD
$100 $10
BLS HCP DVD $75 $10
ACLS HCP DVD $80 $15
PALS HCP DVD $80 $15
AV Kit (Projector, speakers, DVD player,
etc.)
$700 $40
BLS ACLS PALS Heartsaver
Paperwork Binder $50 $5
Epi Pen Trainer $8 $2
Cat Tourniquet $35 $2 S M L XL Box of Gloves
(For purchase only) 50 pair
$15
Mouth Pieces (For purchase only)
10 count
$12
Box of Face Shields (For purchase only)
36 count
$15
EQUIPMENT RENTAL PRICING (per AHA 1 CPR manikin to every 3 students) Amount
Requested DESCRIPTION OF
EQUIPMENT Rental Price
Amount Out In
# Verified By # Verified By
BLS KIT
BLS HCP DVD
4 Adult CPR Manikins
4 Infant Manikins
1 AED Trainer
4 Adult Ambu Bags + Masks
4 Infant Ambu Bags + Masks
$75
Mouthpiece sold
separately
Heartsaver
CPR/AED KIT
Heartsaver CPR/AED DVD
4 Adult CPR Manikins + Mask
4 Infant Manikins + Masks
1 AED Trainer
$50
Mouthpiece sold
separately
Heartsaver First Aid KIT
Heartsaver First Aid DVD
4 pairs of Gloves
1 CAT Tourniquet
1 Triangle Bandage
1 Curlex
1 Pack of 4x4 Gauze
4 Epi Pen Trainers
$35