EQUIPMENT RENTAL FORM
PLEASE PRINT CLEARLY
2630 LANCASTER ROAD UNIT E
(613) 731-ROPE (7673)
City: _____________________Prov/State: ____________________
Postal Code/Zip:_____________ Cell: ____________
(613) 731-8747 fax
Office: ________________ Fax: _______________
$ / WEEK(S)
$ / DAY(S)
INCLUDED WITH RENTAL:
Carabiners # _____
Harnesses # _____
Rented by (print): _______________________________________ Date: ____________________________
Signature: ____________________________________________ Time: ____________________________
Returned by (print): _____________________________________ Date: ____________________________
Signature: _____________________________________________ Time:____________________________
CHECK SRL FOR DEPLOYMENT
Initials ____ PAYMENT METHOD
ALL ITEMS RETURNED
+ GST/HST $_________________
Credit Card #
__________________ Auth #______________________________
Cardholder Name:________________________ Signature : ____________________
RENTAL TERMS AND CONDITIONS
Please Read Carefully
Deposit must be paid for in full at the time of pick-up; payment can be made with cash, Visa, M/C or Amex. Valid photo
identification (driver's license or passport) must be shown for all rentals. Rentals returned late will be charged the single day rate
for each day late. If rental equipment is returned in damaged or dirty condition, the renter will be responsible for cleaning and
repair costs; expenses incurred under this policy will be charged to the deposit. Rentals will be billed at a daily or weekly rate,
whichever is less. The minimum time period is one day. After the initial 24 hours, you will be billed for the second day and
charged another day’s rate every 24 hours thereafter. There will be an additional charge if delivery to your site is required.
If the air monitor reads off-line "OL" / out-of-range "OR" due to atmospheric test results, a re-calibration fee of $ 85.00 will be
applied to your invoice; if a sensor(s) is deactivated and rendered unusable, a replacement sensor(s) will be invoiced. Thank you.
Should the retractable lifeline arrest a fall, a re-certification minimum charge of $ 450.00 will be applied.
A deposit of $ 1,000.00 is required when the rental item(s) are picked-up. Add applicable taxes to above rates.
When the rented equipment is returned, the deposit amounts will be reimbursed, less any damage, cleaning, or late charges.
Any lost, stolen or damaged equipment will be billed at replacement costs. VISA, MasterCard & American Express: Welcome!
SIGNATURE: ______________________________________________ DATE: __________________________
I agree to the above terms and conditions.
equipment rental web form.pdf
Rev. Feb / 11
(Signature(s) will be required when the equipment is picked-up)