This agreement is between the lender Inez de Vega from The Neuro Brain and the Borrower (please insert your name below).
Name *
Name
Address *
Address
Training not Treatment *
I agree to the following
Duration
Please tick if you agree
Condition *
Please tick if you agree
Care of Equipment *
Please tick if you agree
Technical *
Please tick if you agree
Licence Activation *
Please tick if you agree
Rental Extension *
Please tick if you agree
Security *
Please tick if you agree
Signature *
Please tick if you agree
Please place your name below as signature