Damage Waiver
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1Account#_____________
DAMAGE WAIVER
Many Johnny on the Spot/Van Sant customers are experiencing substantial losses due to theft,
fire & vandalism. For this reason, we now offer you a damage waiver. This damage waiver
insures against loss due to theft or major damage to your rental of our units. The cost for the
damage waiver is as follows:
TYPE OF UNIT
COST OF DAMAGE
MINIMUM
WAIVER
RENTAL
Regular
.20/Day/Unit
60 days/unit
Deluxe
.25/Day/Unit
60 days/unit
Celebrity
.40/Day/Unit
60 days/unit
ADA Accessible
.50/Day/Unit
60 days/unit
BILLING NAME
BILLING ADDRESS
CITY/STATE
ZIP CODE
IF YOU ACCEPT
: please complete this portion of the form & return as soon as possible
AUTHORIZED SIGNATURE
DATE
NAME – PLEASE PRINT
TITLE
IF YOU DECLINE
: please complete this portion of the form & return as soon as possible
*IN ADDITION, I AGREE TO PAY FOR ALL DAMAGES & REPLACEMENT COST IF
LOSS OCCURS*.
AUTHORIZED SIGNATURE
DATE
NAME – PLEASE PRINT
TITLE
Rev. 2/09
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Parent category: Legal