Loan Library Security Agreement

This agreement is entered into by Forbes Rehab Services, Inc. (dba Forbes AAC) and the customer listed below. Practitioners are required to provide their ASHA # to validate their identity and responsibility for the loan device if loaned to a facility.

This agreement is entered into by Forbes Rehab Services, Inc. (Forbes AAC) and the clinician listed below. The agreement below defines the terms of an equipment loan.

Practitioners can request equipment for:

  1. Single-case evaluations with a communicator
  2. Long-term placement for multiple ongoing evaluations in one AAC-intensive facility

Regarding Loans to Practitioners (SLPs):

  1. Purpose: Loaned equipment is for assessments with end users who plan on procuring their own AAC device, pending a successful evaluation. The device is to stay with the clinician and not go home with the end user.
  2. Availability: Loans are available on a first-come, first-served basis and are subject to approval by Forbes AAC.
  3. Duration: The loan duration is generally 2 weeks but can be ongoing for AAC intensive clinics.
  4. Consideration: Forbes must approve all requests and will do so on a case-by-case basis.
  5. Review: For long-term loans over 4 weeks, the Clinician agrees to provide (upon request) data regarding the usage of the device. Typically, data will be requested every 4 weeks.
  6. Timely Responsiveness: The Clinician agrees to respond in a timely manner to requests about the order.
  7. Return: The order must be return-shipped on or before the date specified on the order; however, it is mutually understood that Forbes may require that the device be returned at any time. A $250 late fee will be assessed if the order is not returned on the due date or upon reasonable request; an additional $250 fee will be assessed on a weekly basis until the equipment has been returned.  is an agreement to this term and indicates you are responsible for the device's condition and security until it is returned to Forbes AAC.
  8. Damages: The Customer agrees that extensive damages or total loss of equipment are the financial responsibility of the customer. Providing your clinician ASHA number below indicates that you understand and agree to the Terms and Conditions and authorizes Forbes to charge you personally for late or damaged equipment.

Contact Details
Clinician Name *
Clinician Work E-mail *
Pracitioners must use work email
Company
Clinician Phone # *
Address *
City *
State *
ZIP Code *
Country *
If Shipping to a different location:
Please specify address and any delivery instructions
Alternate Phone Number
ASHA # *
REQUIRED
Order number issued in your loan request confirmation email
Which device are you requesting a loan for? *
Select only one from list
Do you need any accessories for this trial?
Select only from the list
Any specific considerations or special requests for this loan trial?