TICKET No
______________________

RENTAL CONTRACT

DATE _______________
BY AND BETWEEN:
RENTAL CONTRACT No
______________________
_____________________________________________________________________________________________________________________________
(Firm Name)   (Address)
HEREINAFTER CALLED LESSOR, AND _________________________________________________________________________________________
HEREINAFTER CALLED LESSEE.

WITNESSETH: That in consideration of the payments and rental hereinafter provided for, and of the terms and conditions hereof, the Lessor hereby agrees to lease and does lease to the Lessee, and the Lessee hereby agrees to lease from Lessor, the following described equipment belonging to the Lessor, to wit:

EQUIPMENT RATES
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
TOTAL VALUE & __________________________
$ __________ PER HOUR
$ __________ PER DAY
$ __________ PER WEEK
$ __________ PER ACRE / TON
$ __________ MIN.CHG.

Above equipment to be used in __________________________________________________________ operations on _____________________________
_________________________ at or near ___________________________________________________ in the State of ____________________________
TERMS OF LEASE: The term of this lease shell be for a period of _______________ hours / days / weeks
beginning with the ______________________ day of ___________________________, _________ at _________ a.m. / p.m.
and terminating the ______________________ day of ___________________________, _________ at _________ a.m. / p.m.
INSURANCE COMPANY: ______________________________________________________________________________________________________
AGENT: ______________________________________________________________________ PHONE NUMBER: _____________________________
RENTAL RATES AND PAYMENT: The rental rates set forth in this contract do not include sales, use or occupational taxes. If and when such taxes are incurred by law, these amounts shall be added to the rental payments due under this contract.

DATE IN ___________________ HOUR ____________
DATE OUT ___________________ HOUR ___________
HOURS, DAYS, OR WEEKS USED ________________
RENTAL CHARGE & ___________________________

REFUND $ ____________________________________

RENTAL CHARGE _______________________
TRANSPORT CHARGE _______________________
TAX _______________________
TOTAL CHARGE _______________________
ADVANCE DEPOSIT _______________________
BALANCE _______________________

No alteration or modification of this Lease is valid unless in writing an signed by the parties hereto. Lessee acknowledges receipt of the signed copy hereof.

ALL TERMS AND CONDITIONS STATED ON THE REVERSE HEREOF ARE A PART OF THIS CONTRACT.
IN WITNESS WHEREOF, the parties hereto have on the da and year first above written hereunto set there hands and seals.

BY SIGNING THIS LEASE. LESSEE AGREES TO THE TERMS AND CONDITIONS SET FORTH ON THE FACE AND REVERSE SIDE HEREOF. ANY DIFFERENT OR ADDITIONAL TERMS, WHETHER WRITTEN OR OTHERWISE,
ARE HEREBY OBJECTED TO AND SHALL HAVE NO LEGAL FORCE OR APPLICABILITY WHATSOEVER.

SAFETY CERTIFICATION
I have read this Equipment Rental Agreement and certify that the information contained herein is true and correct. I certify that at the time of delivery of the leased equipment, I was in the proper and safe operation of the equipment, its safety features and the purposes for which it was designed to be used. I further certify that, at the time of delivery, all applicable safety features of the leased equipment were installed and operational.

LESSEE _____________________________________________ Accepted and Approved ___________________________________ , ____________

By _________________________________________________ LESSOR _____________________________________________________________

Witness _____________________________________________ By __________________________________________________________________

Phone No ____________________________________________