Money Counter Equipment Rental Agreement

Instructions: Print this form and complete it.
Mitchell Enterprises Equipment Rental Agreement
Return completed form to Mitchell Enterprises 1054 Whitegate Road, Wayne PA 19087, or FAX: (484) 585-1687.

Please indicate equipment desired:: [ ] Non Discriminating Currency Counter with Counterfeit detection EB-9000 UV ($32/day, $95/week, 2 day minimum rental); [ ] Heavy Duty Non-Discriminating Currency Counter with counterfeit detect EB-6000 UVMG ($37/day, $110/week, 2 day minimum rental)
[ ] Heavy Duty Discriminating Mixed Bills Currency Counter with counterfeit detect SB-1000 UVMG ( $500/week, 1 week minimum)
[ ] CS-2000 Coin Counter ($47/day, $120/week, 2 day minimum rental)
[ ] CS-600 Coin Counter ( $265/week, 1 week minimum)
[ ] CS-10 Coin Counter ($42/day, $110/week, 2 day minimum rental)

Name: _________________________________________ Company : ____________________________
Address: _____________________________________________________________________________
City: ____________________________ State___________________________ Zip ________________

PHONE ____________________ Ext:_____ FAX ________________ Email _________________
Date(s) Needed: _________________________Must arrive by: _________________________________
Credit Card # ________________________________ Expiration date: _________ CV code: _________
Name on card: ____________________________ Comments:__________________________________
1. Equipment will be inspected by Mitchell Enterprises personnel prior to rental
2. Equipment should be returned in the condition in which it was received. If our staff must spend extra time cleaning the equipment, the renter will be charged for this service.
3. If the equipment is damaged and/or lost due to negligence on the part of the renter or his/her staff, the renter will be responsible for any repair work or replacement of machine.
4. If the equipment is not shipped back within 48 hours after its use, the renter will be charged for each additional day that the equipment is out, unless prior arrangements have been made. Tracking information will be used to determine date of return shipment. Equipment MUST be returned to Mitchell Enterprises, 1054 Whitegate Road, Wayne PA 19087.
5. Equipment must be returned in it's original packing box, with all the original accessories and instructions and with original packing.
6. Insure return shipment for full value. Renter is solely responsible for entire loss if machine is damaged or lost in shipment. Renter will need to file any insurance claims with their shipping company and will be responsible for full value of losses regardless of shipping company claims compensation.
7. Renter will be charged for outgoing shipping and renter will be responsible for return shipping charges.
8. Renter's credit card will be authorized for full value of the machine and actual charges will be made when machine is returned.

Authorized Representative Signature and Date . By signing this , I agree to all terms and conditions.

Signed ______________________________________ Print Name _______________________________Date __________________; Return to Count-Money.com