By signing, I agree to indemnify and hold harmless Plumsted Pharmacy from and against any and all liability, loss, damage, expense (including legal expense), cause of action, suits, claims or judgments arising from injury or death of persons or damage to property, of any nature whatsoever, resulting from the actual or alleged presence, use, or operation of the equipment, provided such injury, death or property damage is not attributable to the negligence of Plumsted Pharmacy.
Plumsted Pharmacy owns the equipment that is being rented and I agree to not give or transfer possession of the equipment to anyone else. The equipment must be returned to where it was received. If the equipment is lost or stolen, I authorize DME to charge $450 for the replacement cost of a knee scooter and $375.00 for a wheelchair, $250 for transport chair, and $200 for a rollator walker. I understand that the weight capacity of the equipment is 300 lbs and I or the person using the medical equipment am/are within that limit. I will be instructed on the use of the equipment and operation safety when I recieve the medical equipment . I understand the Plumsted Pharmacy staff are available Monday to Friday 8:30am to 8:30pm, Saturday 9am to 6pm, and Sunday 9am to 3pm should I have any questions. I authorize Plumsted Pharmacy to debit my credit card in the amount shown below and in this form. This agreement contains the entire understanding of the parties.