Roland Priestley Mobility Centre Knee Walker Rental

Full Name*

First NameLast Name

Home residential address no PO boxes. *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number

Area CodePhone Number

Contact Phone Number whilst in Sydney*

Rental start date (Weekdays only)*

Rental return date (Weekdays only)*

Aprox weight of person using the Knee Walker in kgs?*

(Max Weight capacity 120 kg)

Name of person picking up the Knee Walker

Only fill this out if it is another person

Weight & Safety Agreement*

By ticking the box I declare the user of the knee walker is under 120 kgs and agree not to overload the Knee Walker. I also agree to use it only on flat surfaces and at a speed at no greater than walking pace, I will follow safe operating procedures.

Brake Agreement*

The Knee walker has a braking system. If used excessively the wheels are easy to lock up. Locking the wheels creates flat spots on the wheels. The knee walker is provided to you without flat spots. I agree if I return the Knee walker with flat spots on the wheel/s I will pay $30.00 per replacement wheel.

All Knee Walker bookings are prepaid only by Visa or Mastercard at the time of booking.

TERMS AND CONDITIONS

1. The period of hire of the equipment will commence on the date on which the goods are delivered and or picked up from Roland Priestley Pty Ltd. In effect the time it leaves our premises and is returned to our premises. Courier delivery and pick up days are counted as rental days.
2. The knee walker is uninsured, The hirer accepts full responsibility for any damage to the knee walker or any injury or damage to the knee walker user or other persons or property as a result of operating the Knee Walker. I authorise Roland Priestley Pty Ltd to charge the supplied credit card for any repairs to the rollator up to the value of the rollator without consulting the card holder for any damage or loss.
3. The knee walker is uninsured, if the knee walker is lost or stolen the hirer excepts full responsibility for the knee walker and authorises Roland Priestley to charge the supplied credit card up to and including the replacement value of the knee walker for any loss or damage without consulting the card holder.
4. Roland Priestley Pty Ltd agrees to provide the knee walker free of defects and in operational order. If the knee walker were to fail during the hire period we will refund the unused portion of the hire or replace with an equivalent model at the hirers discretion. You the hirer agree Roland Priestley Pty Ltd is not responsible for any compensation beyond the knee walker hire cost.
5. The hirer agrees NOT to repair or modify the knee walker in any way without the written approval of Roland Priestley Pty Ltd
6. An extension of hire may be extended by both parties agreeing. If an extension of rental is granted there is no need to fill out another agreement. This agreement will remain in force until the knee walker is returned.The customer authorises Roland Priestley Mobility to charge the supplied card for any extension of rental at the advertised rate. A recept will be supplied.
7. Cancellation of hire: Hire is prepaid at the time of booking. Cancellations are accepted before the hire period has commenced. The hirer agrees to a $22.00 admin charge for cancelling the hire of a knee walker, the balance will be refunded to the credit card number supplied. Once the rollator has been dispatched I the hirer agree to no refund for change of mind or change of circumstances.
8. I agree to pay the rental rates advertised on the Roland Priestley website
9. I agree not to use the Knee walker in the shower.
10. If the knee walker is not returned on time I agree to pay any overdue charges and authorise Roland Priestley Mobility to charge the supplied card.
11. If using the courier service and the knee walker is not available for pick up at the time booked. If the courier has to return for a second trip I the hirer agree to pay for this extra courier service chargeable to the credit card supplied.
12. I agree to not overload the rollator and follow safe operating procedures. The load capacities are advertised on the Roland Priestley webpage.
13. The Hire period will terminate should any of the following occur and Roland Priestley will be entitled to the return of the equipment. A) The hirer makes default in the payment by the due date of any fees or other amounts outstanding, or otherwise defaults in the service or performance of any terms of this agreement. B) The hirer does, or causes to be done, any act matter or thing to which is likely to endanger the safety of persons, condition or safe keeping of the equipment. C) Any other event occurs which constitutes, or evidence, on the hirers part a repudiation or refusal to be bound by the agreement.
14. The hirer warrants that he/she is authorised to make this agreement on behalf of all persons who possess, use or operate the equipment during the period until the equipment is returned.
15. The hirer accepts full responsibility of the rollator at all times if left with a hotel concierge or reception up until the rollator is picked up by the courier.
16. Roland Priestley accepts responsibility of the condition of the rollator while in the hands of the courier. If the Knee Walker is delivered damaged, the hirer MUST notify Roland Priestley Pty Ltd immediately so another knee walker can be dispatched and the damaged one picked up. No claims for courier damage will be accepted after 24 hours after delivery.
17. I aknowledge the Knee walker is only to be used by the person renting the item and is not to be used at a speed in excess of walking pace.
18. I agree to only use the knee walker on flat surfaces.

Terms and conditions agreement*

By submitting this rental agreement and signing below I have read and I agree to Roland Priestley Pty Ltd Knee Walker Rental Terms and Conditions.

Signature

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