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Portable Oxygen Concentrator Battery Rental

Thank you for choosing Vienna Medical as your portable oxygen concentrator source. Fill out the online rental form below to secure your POC rental today. Your credit card will be charged the entire amount of your rental including shipping and a refundable security/damage deposit of $50 per battery. Our second option is to print and fax your rental form and credit card authorization form. This second option allows for your credit card to be charged a deposit amount of $50 for your rental and the remainder to be charged at time of rental. Call customer service should you have any questions. 1-800-489-8165 (Credit card authorization and rental forms found here)

ALL ITEMS MUST BE RETURNED CLEAN AND IN
ACCEPTABLE CONDITION AS WHEN FIRST RENTED
.


Start Date:    


Batteries are $50 for the first 7 days - $8 a day after that. Check off each battery desired.


For rental periods over 1 month please call us at: 1-800-489-8165
.

Select A Portable Oxygen Concentrator*:    

Be sure to specify number of days per battery.

    Battery 1    Number Of Days For Extra Battery 1:

    Battery 2    Number Of Days For Extra Battery 2:

    Battery 3    Number Of Days For Extra Battery 3:

    Battery 4    Number Of Days For Extra Battery 4:

    Battery 5    Number Of Days For Extra Battery 5:

    Battery 6    Number Of Days For Extra Battery 6:

    Battery 7    Number Of Days For Extra Battery 7:



PLEASE READ AND AGREE TO TERMS

Terms: Initial rental is due along with any other applicable charges and a $50 Security Deposit per battery before delivery can be made. If an extension is needed we must have at least a 72 hour notice. An additional week or daily rate of rental begins the following day after your initial week of rental should it not be returned on scheduled date. Rental on equipment starts the day the equipment is received in home or is picked up and stops when the equipment is shipped out from your location or dropped off.

The Customer is responsible for replacement costs of damaged, missing or permanently stained rental equipment. WARNING: Florida statute 812.021 sub section 7 provides that failure to return rented equipment as agreed at time of rental is considered prima facie evidence of larceny and will be prosecuted. In the event Shenk Enterprises, LLC. d.b.a. Vienna Medical institutes legal proceedings to recover missing property or damages arising from the contract, we will be able to recover Legal fees along with any additional costs to damaged equipment. Test and (or) Repair Charges - If returned equipment appears broken due to misuse, a test and repair charge of $50.00 may be charged for inspection, testing and minor repairs required to return the Equipment to service. This charge will be payable at the end of this agreement. If the equipment cannot be repaired, the customer will be notified and will be responsible for the designated replacement cost of the Equipment.

Shipping is $50 for the first 4 batteries and an additional $50 for a 5th battery. (This covers the item to be shipped ground to the patient and back to us) A paid delivery tag will be included with the items when shipped. Simply use the same box, put the new delivery tag on it and ship. Additional shipping & billing info to be added at checkout

Security Deposit - $50 per battery for domestic travel*, fully refundable upon undamaged return of unit.
*For international travel please call us at 1-800-489-8165

Limitation of Liability and Indemnity:
Limitation of liability - In no event will Shenk Enterprises, L.L.C. or Vienna Medical be liable to the Customer for any Incident or injury, indirect or consequential damages however caused, whether by negligence or otherwise relating to renting or using any medical equipment.

Indemnity - The Customer agrees to protect, indemnify and hold harmless Shenk Enterprises, L.L.C. from and against all claims, damages and costs including legal expenses arising out of Customer's use of the equipment.

By checking the box below and submitting you are stating that:

I agree that I have been instructed on how to use the equipment and take full responsibility for the proper use and care of the equipment during the rental period so that it is returned in the same condition as when received.

I fully understand that I am responsible for any and all damages and therefore repair costs and late fees that may arise should the product be damaged during my rental period or during packaging for return.

Any outstanding balances as a result will have $175 per month late fee until balance due is received.

Should the product be damaged during shipping, Vienna Medical will issue a claim to the shipper and it will be investigated.


You will be contacted within 48 hours for a verbal confirmation.

BEFORE SUBMITTING PLEASE MAKE SURE ALL REQUIRED FIELDS ARE FILLED OUT AND ALL INFORMATION IS CORRECT!

Any Additional Comments:  


  I have read and agree to all terms.