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Contact *

First Name

Last Name

Contact Phone

(###)

###

####

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Delivery Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Height of Stand

Short Stand (1 foot)

Tall Stand (3 feet)

Rental Agreement Waiver *

This is a contract of renting, the undersigned renter agrees that he/she has rented item(s) herein described upon the expressed conditions that will at all times remain the property of APMSW, Inc.: that he/she has examined said item, found it to be in good condition as when he/she received it, ordinary wear and tear accepted, that he/she will pay promptly, when due, all charges which accrue because of this rental, including damages to said item. In the event the renter fails to return said item at the assigned time or fails to abide by any of the conditions of the contract, APMSW, Inc., is hereby released from this rental contract. All charges are based on the time item is in renters possession whether in us or not. Payment terms are Net 15. There will be a finance charge on all past due accounts. There is a $20 fee charged for all NSF checks. APMSW, Inc is not responsible for accidents or injury caused directly or indirectly in the use of rented item(s). Bottles are property of APMSW, Inc. and are not for sales. Rent is collected monthly. WARNING: CONTACT WITH WATER FROM HOT TAP COULD RESULT IN INJURY.

I accept and understand the waiver