Rental Agreement Form

Billing Details

Company Name

Street Address

Suburb

State

Post Code

Contact Name

Contact Phone

Contact Email

PO Number

_{(Please provide a copy of your PO)}

Delivery Details

Same as Billing AddressDifferent from Billing Address

Unit Details

Instrument (Make/Model)

Despatch Ship Date

Contract Start Date

Contract End Date*

Return Ship Date

Contract Length

_{*Should you wish to extend your hire, please contact our Rental department prior to the end date listed above. If no request is made and the units are not returned at the end of the contract you will be invoiced for the additional period accordingly.}

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Add another unit

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Delivery Method

Select from options below, minimum freight charge $40 + GST
Pick up from Melbourne OfficeOvernight ExpressRoad Express

Return Method

Select from options below
Customer to arrangeKenelec Scientific to arrange (standard freight cost applies)

_{All services offered by Kenelec Scientific are subject to our terms and conditions.}

Signature

Name

Date

_{I / We hereby agree to rent the equipment above, subject to availability, in accordance with these arrangements, Terms & Conditions, and warrant that I / We have authority to sign this agreement on behalf of the above-mentioned company.}