We hereby ACCEPTWe hereby DECLINE
By submitting this form I acknowledge that I have read and understand the agreement.

See terms and conditions below
Company:
Contract No.:
Job Reference:
Unit Nos.:
* This is for each individual unit on this contract

DAMAGE WAIVER TERMS AND CONDITIONS

I. If damage waiver agreement is accepted, the lessor, Mr. John, agrees to modify the standard rental agreement as follows in
consideration of amount ($) quoted per unit for standard units, flush units, hi-rise units and/or wheelchair accessible units.

(a) Lessee is relieved of responsibility for theft or major structural damage to rental equipment owned by lessor, with the exception of a $150 deductible for a standard unit, $200 deductible for a flush unit, $275 deductible for a hi-rise unit and $400 deductible for a wheelchair accessible unit.
(b) Notwithstanding the foregoing, the lessee agrees to provide the lessor with a copy of a police report of said theft or damage (if a result of vandalism) within fourteen (14) days of occurrence. (Damage waiver will not be pro-rated.)

II. If damage waiver is declined, lessee understands that the terms of the standard rental agreement remain in full effect. Terms are as follows:

(a) The customer agrees not to cause the equipment listed in the contract to be removed from the site address without specific written permission or consent from Mr. John.
(b) The customer agrees to pay for any damage or loss of the equipment as an insurer, regardless of cause or fault, except for reasonable wear and tear while the equipment is at the site address.
(c) The lessee must provide Mr. John with a copy of a certifi cate of insurance if the damage waiver is declined.

Your Name:
Email Address: