Hiring Form & Agreement
Please Complete and email back to
Date:………………………………… Return Address:
Machine Serial #:…………………. / 20 Pitchford Rd
Northcliff 2195
Contact: 0846024234
Name: / Surname:
ID Number: / Cell No:
Home No: / Work No:
Email Address:
Courier Required: / Deliver to Home or Work:
Physical Address: / Work Address:
Postal Address: / Husbands Name:
Husbands Cell:
Code:
TERMS AND CONDITIONS
Rates for hiring of the Ameda Elite hospital grade pump:
  • R1000 refundable deposit,
  • R 400 Ameda Double Hygiene Kit(50% Discount)
  • R800 monthly rental
Total: R 2200.00 / Please send proof of payment to
Our banking details are:
Bank: FNB
Account name: Family Kitchen
Branch code: 250655 Cresta centre
Account type: Cheque account
Account number: 62585363444
Renter acknowledges that they use this hospital grade pump at their own risk and FamilyKitchen is not liable for any injury that may occur due to the handling or use of this pump.
The breast pump will remain the property of FamilyKitchen.
The renter acknowledges that if the machine returns with any damage that were not first stated when I originally hired it, I will be financially responsible for these repairs.Renter agrees to return to breast pump in the same condition as received.
I acknowledge that I will only use the Ameda Hygiene kit to operate this Ameda Breast Pump. Renter assumes all responsibility for any damage to renter or breast pump if any kit other than the Ameda Hygiene Kit Milk collection system is used for milk collection.
Renter must notify the FamilyKitchen within 2 day of receipt of the pump if damage is noted, otherwise pump will be assumed delivered in good condition. Renter agrees that if they do not return the breast pump they will be liable for the current suggested retail price for any damage/missing parts on return of the breast pump.
Renter agrees to pay all repair costs for damage incurred during the rental period.
This agreement shall terminate upon written notice by the FamilyKitchen or the renter and shall terminate on return of the breast pump either by courier or self-delivery.
SIGNED:…………………………………………………. / DATE:…………………………………………………..
PLEASE ALSO SEND COPY OF ID AND PROOF OF ADDRESS THANK YOU!