Hospitals & healthcare
Medical equipment loan record template (US)
A general template under US law. Laws differ from state to state, so check it against your state's law or with a lawyer licensed there. We are not a law firm and do not give legal advice.
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Equipment Loan Agreement
This Agreement is made on Effective Date between Lender Name, at Lender Address ("Lender"), and Borrower Name, at Borrower Address ("Borrower").
1. Equipment
| Item | Serial Number | Condition | Replacement Value |
| --- | --- | --- | --- |
| First Item | First Serial Number | First Condition | $First Value |
| Second Item | Second Serial Number | Second Condition | $Second Value |
2. Loan Period
The loan runs from Loan Start Date to Return Date, and the equipment will be kept at Storage Location. Lender may ask for it back earlier on Recall Notice Days days' notice. The loan fee is: Fee or None.
3. Use and Care
Borrower will use the equipment only for Permitted Use, only by trained people, and as the manufacturer instructs. Borrower will not lend it to anyone else, alter it, or let any lien attach to it. Lender stays the owner.
4. Inspection
Borrower has inspected the equipment and accepts it in the condition listed above. Borrower will report any problem at once, and will stop using it if it appears unsafe.
5. Loss or Damage
Borrower is responsible for loss, theft or damage during the loan, other than normal wear, up to the replacement value or the cost of repair. Borrower will keep insurance for it: Insurance Required Yes or No.
6. Return
Borrower will return the equipment clean and working, with all parts, to Return Location. If it is late, a charge of $Late Charge per day applies, to the extent the law allows.
7. No Warranty
THE EQUIPMENT IS LOANED AS IS, WITHOUT WARRANTIES, TO THE EXTENT THE LAW ALLOWS. Lender will tell Borrower about any defect it knows of. To the extent the law allows, Borrower is responsible for injury or damage caused by its use of the equipment, except where caused by Lender's gross negligence or a known defect not disclosed.
General Terms
Governing law. This Agreement is governed by the laws of the State of Governing State, without regard to its conflict of laws rules. Any lawsuit will be brought in the state or federal courts located in Venue County and State.
Entire agreement. This Agreement is the parties' complete agreement on its subject and replaces all earlier discussions. It may be changed only in a writing signed by both parties.
Severability. If a court finds any part of this Agreement unenforceable, that part will be enforced to the extent the law allows, and the rest stays in effect.
Notices. Notices must be in writing and sent to the addresses above by personal delivery, certified mail or a nationally recognized courier.
Counterparts and e-signatures. This Agreement may be signed in counterparts and by electronic signature, which has the same effect as an original.
| Lender | Borrower |
| --- | --- |
| Signature: Lender Signature | Signature: Borrower Signature |
| Name: Lender Printed Name | Name: Borrower Printed Name |
| Date: Lender Signing Date | Date: Borrower Signing Date |