Complete Equipment Reservation

Confirm your hire dates, security deposit authorization, and contact details.

Hire Start Date & Time

Hire Return Date & Time

Lessee Information

Full Name

Email Address

Phone Number

Fulfillment Method

Customer Depot Pickup Collect equipment directly from our yard

Jobsite Delivery & Drop-off Direct courier or transport to your address

Delivery Address

Delivery fee may apply depending on distance and transport requirements.

Health/Medical Requirements

Physician Order / Prescription # (If Applicable)

Reference number for insurance or healthcare records.

Patient Weight in Lbs (for equipment weight capacity) *

Crucial for safe load and bariatric mattress ratings.

Primary Caregiver / Attendant Contact Info

Contact for delivery handoff and orientation.

Non-Emergency Home Healthcare Device Disclaimer & User Orientation * Acknowledges equipment is not for life-support emergency care.

Hospital-Grade Sterilization & Hygiene Seal Receipt * Confirms delivery with intact antimicrobial sterile wrap.

Promotional or Partner Coupon

Protection & Deposits

Opt-In Damage Waiver Coverage Covers minor equipment wear, hydraulic line scuffs, and inadvertent jobsite wear.

HOME HEALTHCARE EQUIPMENT RENTAL & MEDICAL WAIVER

Lessee acknowledges that rented medical and mobility equipment is not a life-support system and must NOT be used for acute life-threatening medical emergencies. Lessee confirms receipt of operational orientation. Equipment must be operated strictly within the specified patient weight capacity. Pre-delivery sterilization seal guarantees hospital-grade hygiene.

By submitting this checkout, you authorize a temporary pre-authorization security deposit hold. No funds are captured until pickup inspection, and holds are automatically released upon equipment return in agreed condition.