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PRIVATE CLIENT HIRE REQUEST FORM

This is a request to hire: Pick Up Frame with wheels

Name:*
Phone:
Fax:
Email:*

I prefer my invoices to be sent by Email

Billing Address:
Delivery Address:
Start Date:
End Date:

I will require FLM to pick up the equipment when hire ceases.

NOTE: There is a minimum hire period of two (2) weeks
Billing will continue to be sent fortnightly until FLM is notified of the Hire End Date

Additional Comments:

PATIENT HIRE AGREEMENT AND AUTHORISATION

I understand that to secure this hire agreement I MUST complete a security form provided with valid Credit Card details and by doing so I give Fisher Lane Mobility authorisation to deduct any amounts owing on this account after the due date(s) stated on each invoice.

I have read and agree to the full terms & conditions of this hire agreement:

Submit the hire request and our hire team will be in contact during business hours to confirm stock availability, delivery and collection fees (if applicable) and confirm payment details.

TERMS & CONDITIONS

  1. All hires will be charged for a minimum two (2) weeks hire charge.
  2. A Hire Agreement form and Security form must be completed prior to the commencement of hire. The agreement confirms hire and authorises payment method.
  3. The period of hire shall commence on the date of delivery or collection of the equipment from Fisher Lane Mobility and shall cease on the date confirmation is received from the client arranging for the equipment to be collected or on the date the client returns the equipment to Fisher lane Mobility.
  4. Payment methods for hire equipment are by Credit Card, Direct Debit, Cheque or Cash. Payment is required on a fortnightly invoice or direct debit.
  5. If payment has not been received by the due date, the outstanding invoices will be charged to the security card provided.
  6. Payment for the initial two (2) weeks hire and delivery, if required must be paid prior to or on receipt of receiving the hire equipment. Direct Debit is available, on authorisation from the client for the duration of the required hire period.
  7. Credit card details and proof of identification must be supplied prior to the commencement of hire.
  8. All interstate clients need to present both their Driver's licence and a bond payment equal to the RRP of the product being hired.
  9. If Credit Card details are not provided, the client must provide banking details and authorisation to for Direct Debit for overdue payment(s) before hire commences.
  10. Delivery charges and collection fees apply.
  11. Fisher Lane uses their own delivery personnel or company representatives for all deliveries. All staff hold current police checks.
  12. Equipment must not be relocated from the place of delivery without prior consent from Fisher Lane Mobility
  13. All prices are subject to change without notice.
  14. All equipment remains the property of Fisher Lane Mobility.
  15. All equipment should be returned to Fisher Lane Mobility in good working order. If any repairs or excessive cleaning is required, then the client shall be liable.
  16. All equipment is safety checked and sanitised prior to delivery
  17. All repairs to be conducted by Fisher Lane Mobility staff or representative only.
  18. The client assumes all liability for all injuries and damages or both as the case may be, that may be caused or sustained through the operation of the equipment.
  19. Fisher Lane Mobility may end the hire agreement if (a) payment is not received by the due date (b) Equipment is damaged or misused.
  20. The cancellation of hire must be given minimum 48 hours prior to the commencement date of hire. Should a cancellation notice be given in less than 48 hours a cancellation fee may apply.