Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Training not Treatment *

Please tick if you agree.

I agree with the following : In renting a system I understand that NeurOptimal® neurofeedback is not a medical treatment, device or methodology. It is not used to diagnose medical disorders nor is it used as a medical treatment for disorders and has not been approved for any medical purpose by the TGA or any other governing agency. NeurOptimal® is solely as a tool for brain-training and optimization and not as a means of diagnosis or as a medical intervention. I understand that it is not possible to predict what my central nervous system will do with the information it is offered and consequently there can be no guarantee as to the results of my training.

Duration

Please tick if you agree.

I agree with the following : This loan is for a period of 12 (twelve) weeks and covers any extension to the lending period provided consent for an extension is obtained by the borrower and given by the lender (Inez de Vega). However, the lender reserves the right to request return of the equipment at any time. In such an event, the borrower will be refunded the unused number of days. If the borrower wishes to return the equipment prior to completion of the contract there will be no refund for unused time.

Condition *

Please tick if you agree.

I agree to the following : No more than two sessions in a day per user. Fees are due prior to delivery. Acceptable forms of payment are: Cash or Bank Deposit. If borrower returns the system after the due date, the lender can, at her discretion, charge a rate of $80 per day rental for time overdue. Failure to return the equipment within 7 days following the termination of this contract will result in the borrower’s credit card being charged at Zengar’s pricing for hardware only - excluding licence. (Current Pricing: Computer $2995 USD; Z-amp $1970 USD; Sensors $130 USD; Sundries: cords, headphones, paste & carrying case $200 USD; Four weeks rental fee $1300 AUD; plus 10% GST (USD) on replacement of equipment.)

Option

Care of Equipment *

Please tick if you agree.

I agree to the following: As the Borrower, I accept personal responsibility for the care of the equipment at all times. In the event of a technical problem, I will log in for a ZenConnect call with Zengar technicians in Canada (after 10pm Melbourne time) at Inez’s request if needed to troubleshoot the system. There will be no charge for this service. No alterations, work or additions may be made to the computer at any time except by Zengar Institute technical staff. I understand that compensation for lost, damaged or stolen equipment is the responsibility of the Borrower and insurance for the equipment is the responsibility of the Borrower. As the Borrower, I know I will be liable for any damage or losses to the system. Therefore, I am STRONGLY ENCOURAGED to consider adding the NeurOptimal neurofeedback system to my current home contents insurance policy for the rental period (approximately $30 per month).

Technical *

Please tick if you agree.

I will contact Inez immediately if there are any technical issues to avoid any downtime. I understand that minor issues can occur and can be rectified quickly. If I do not contact Inez immediately, I void my right to request an extension to the rental period.

Licence Activation & Internet *

Please tick if you agree.

I understand that I must connect to the internet while using the NeurOptimal neurofeedback program otherwise the program license will be deactivated. (Please note that as the owner, Inez has the ability to deactivate the system remotely in the event that the system is stolen.)

Rental Extension *

Please tick if you agree.

If I wish to extend my rental for a second term, I will let Inez know at least TEN DAYS BEFORE my rental period is due to expire. Otherwise Inez will assume I will be returning my system. I understand that it may not be possible to request a rental extension for a second term if this date has passed and the system is already booked out.

Security & Deposit *

Please tick if you agree.

I agree to providing Inez with a security deposit of $1300 in the form of cash or a bank deposit, which is fully refundable as long as the system is returned undamaged.

Driver's Licence & Credit Card Details *

Please tick if you agree.

I will also email Inez an image of my Credit Card (front plus CVV number on back) and Driver's Licence (front and back) prior to renting. These images can be texted securely through Signal (download the app) or by opening a free email account with ProtonMail. Both Signal and ProtonMail are encrypted facilities. Please consider this condition carefully because if you don't agree to sending Inez these details, then renting a system may not be the best option for you. (Inez can also help you to purchase a system on finance, which may be a better option.)

Signature *

Please tick if you agree.

As the Borrower, by typing my name below (which on this form acts as my signature), I am agreeing and committing to this lease contract. By signing this form I accept full responsibility for the safety and return of the equipment. By signing this form, I agree to abide with all the conditions stipulated on this form.