EQUIPMENT RENTALEquipment Rental • October 27th, 2023
Contract Type FiledOctober 27th, 2023CUSTOMER DETAILS CAREGIVER DETAILS Full Name: Full Name:Relationship to Customer: Contact Phone: Contact Phone: Contact Email: Contact Email: RENTAL DETAILS DELIVERY ADDRESS Start Date: Street / Unit: End Date: Suburb/City: State: Postcode: Delivery attn to: Bill to [please select]: Customer Scheme Plan Manager SCHEME/FUNDER DETAILS PLAN MANAGER DETAILS Plan Name: [eg. NDIS] Plan Name: Participant Number: Client Reference Number: Contact Name: Contact Name: Contact Phone: Contact Phone: Contact Email: Contact Email: PAYMENT DETAILS Payment Type [please select]: Credit Eftpos Account (Credit card details must be entered via Payway)Billing Period: Monthly Weekly (Note: Weekly billing incurs a once-off $50 admin fee) NOTES