I hereby authorize Performance Mobility & Home Healthcare Solutions to charge the provided credit card for any costs associated with lost or damaged equipment during the rental period.

In the event the rented equipment is not returned by the agreed upon date, I understand and consent to a recurring charge being applied to my credit card until the equipment is returned.

I confirm that I am aware of the proper use, function, and safe operation of the rental equipment. I accept full responsibility for its operation during the rental period.

Performance Mobility & Home Healthcare Solutions shall not be held liable for any injuries or harm that may occur as a result of using the rented equipment. It is my responsibility to ensure safe use at all times.