Products Services Ordering Support Product Support About Us Careers Contact Us Hygiena EnSURE Demonstration Request Form DEMONSTRATION EQUIPMENT AGREEMENT This demonstration equipment agreement (the AGREEMENT), as of the date set forth below, between Hardy Diagnostics™ (COMPANY) and CUSTOMER (identified below), sets forth the terms and conditions for the loan of the products or parts listed below (the EQUIPMENT). This equipment is provided for the sole purpose of demonstration and evaluation by the CUSTOMER. CUSTOMER hereby agrees that the loan of such EQUIPMENT shall be subject to the following terms and conditions: TERMS AND CONDITIONS: 1. Upon receipt of EQUIPMENT, the CUSTOMER will verify the working condition of EQUIPMENT and agree to contact the COMPANY Product Manager immediately if the EQUIPMENT is not in good working order. 2. The CUSTOMER will abide by the mutually agreed upon demonstration timeframe. Unless other arrangements have been approved by COMPANY, the CUSTOMER will ship the instrument(s) and related accessories back to COMPANY by the due date indicated on included Packing List, using the shipping labels provided by the COMPANY. 3. EQUIPMENT not returned within agreed upon time frame will result in the unit being billed to CUSTOMER at the regular published list price. 4. EQUIPMENT returned to COMPANY must be in the same working and physical condition as it was at the time the EQUIPMENT was delivered to the CUSTOMER by the carrier: a. Use the original packaging, both inside and outside. b. All returns must be complete with manuals, cables, and any accessories received with original shipment. c. EQUIPMENT must be clean, per provided protocol, and free from signs of visible damage. d. Use the shipping label provided for the EQUIPMENT return. If there is no shipping label, please contact COMPANY so that COMPANY may forward one. If the EQUIPMENT is not returned in good condition, the CUSTOMER will be liable to the COMPANY for the amount necessary to restore the EQUIPMENT to its original condition. If the EQUIPMENT is not restorable, it is the COMPANY’S sole discretion to determine replacement cost, which will not exceed the retail value of the EQUIPMENT. Preceding Terms and Conditions Accepted by: Signature:* Name: First Last Company:* Title:* Date:* MM slash DD slash YYYY DEMONSTRATION UNIT REQUESTED Catalog No.: Accessories: Shipping Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country Preferred Demo Start Date:* MM slash DD slash YYYY Preferred Demo End Date* MM slash DD slash YYYY Demo Contact Name:* First Last Phone:* Email:* Upon submission, a copy of this form will be emailed to the address provided. 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