Lease Request Form

Please note. Leasing is approved on a case by case basis. Requesting a lease does not give the right to receive a leased machine.

Organization Requesting Lease or Time Payment
Name of Organization*
Name of Person Placing Order*
First Last
I am an authorized representative of my company with the authority to request this lease.*
- Yes
- No
I further agree that in the event that a payment is missed the Meridian DPA device and all peripherals will be returned within 30 days in good condition or I will be liable for the full cost of the machine and any legal fees involved in the collection process.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Texas- Lease of Meridian Digital Pulse Wave Analyzer or Cardio WA
Deposit Required First and Last Month =$1000.
Monthly Leasing Fee: $500.00
Lease Term: 24 months

Leasee/Eqiupment Return:
Long Life Cardio
111 Joe Wimberley Boulevard, Suite 1304
Wimberley, TX 78676
Payment Plan- Meridian Digital Pulse Wave Analyzer or Cardio WA
Full Retail Cost of Device: $8495.00
Initial Payment: $3000 Monthly Payment: $500.00
Lease Term: 11 months

Leasee/Eqiupment Return:
Long Life Cardio
111 Joe Wimberley Boulevard, Suite 1304
Wimberley, TX 78676
Number of Lease Units Requested*

Organization Requesting Lease or Time Payment