TENS Unit Rental Agreement

Name (First & Last)*

Mailing Address*

Email Address*

Telephone Number*

My Estimated Due Date is:*

I understand that this is a 5-week rental for the Elle TENS Machine and I must return it by the date: *

Price*
I understand that the price of this rental is $80 with a refundable $60 deposit for a total of $140 due at the time of singing this agreement.

Release of Liability*
I fully understand that Lavender & Mint Maternal Support Services (Jodi Guererri) is not a doctor or licensed medical provider and can not recommend or prescribe medical advice. I also understand it is my choice to use the Elle TENS Machine, and my responsibility to communicate with my medical provider any concerns I may have regarding the use of a TENS machine in pregnancy or labor. I also understand that if I have any pre-existing conditions, particularly those relating to the heart, skin, or epilepsy, it is my responsibility to consult my medical provider before the use of a TENS machine. Jodi Guererri assumes no responsibility for use of the Elle TENS Machine.

Security Deposit Refund*
I understand that my $60 security deposit will be fully refunded to me upon the return of the rented Elle TENS Machine within 1 week of my rental period so long as the Elle TENS Machine is returned complete with ALL COMPONENTS, undamaged, and in good working order. (please do not return used electrodes)

Components Include:
• Babycare Elle TENS Machine
• 4 large Maternity Electrode Pads (do not return used pads)
• 2 lead wires plus 1 spare
• 2 AA batteries plus 2 spares
• Neck cord & carrying pouch
• A Women's Guide to Drug Free Pain Relief
• Instructions & Quick Start Guide
• Accompanying Electromagnetic Information
• Item Packaging: Plastic latch box (excluded if item is shipped), 4 zip lock baggies

Lavender & Mint Maternal Support Services does not provide shipping and will only ship under special circumstances.

I understand that if the Elle TENS Machine is shipped to me, I assume all responsibility for shipping fees including return shipping and any damages received while shipping.

I WILL NOT THROW AWAY ANY SHIPPING MATERIAL and will return the Elle TENS Machine back in its original shipping package with its original shipping material and the batteries removed from the device. This is to ensure the machine is well protected during shipping and to decrease the likelihood of damage.

Shipping Components Include:
• Original Elle TENS Machine box with an insert and bubble wrap
• Picture of how to correctly put the Elle TENS Machine back into its box
• Shipping box
• 10 Airplus bags

Cancellations*
I understand that if I choose to cancel my rental agreement, I must do so 48 hours in advance of the start of my rental period or before the Elle TENS Machine is shipped to receive a refund, and all but my $25 booking deposit will be refunded.

I agree to all terms and conditions

Signature*

Today's Date*

Thank you for choosing Lavender & Mint Maternal Support Services for your TENS rental! Please feel free to reach out with any additional questions.

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