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Rental Form

  • * = Required

  • Personal Information

  • Have you rented this equipment before?
  • Rental Information

    • Dates

  • Can we leave the equipment at the front desk?
  • Is the front desk on the same property as the unit?
  • What floor is the unit on?
  • Are there stairs or an elevator?
  • Is there a code for the gate or door you can provide for access?
  • Rental Terms and Conditions:

    Completion of this form does not guarantee availability.
    Please note that times will be treated as requests. We cannot make special time accommodations for deliveries or pickups on Saturdays. Any special requests will need to be made between you and your destination. If you must have a piece of equipment upon arrival, you will need to get permission from your destination and provide us with the details.

    We do have a cancellation policy available at
    http://www.burkespharmacy.com/dme-#rentals

    Once a delivery is made we do not offer refunds of any amount.

    People renting a "Beach Wheelchair" should be aware these chairs have a seat height of 31" from the ground. We only delivery BWC's to the beach access that will be used as the "BWC" is not for use on hard or rocky surfaces.

  • SHIPPING & DELIVERY POLICY

    Burke's Main Street Pharmacy's shipping & delivery policy is as follows:

    On-Island Deliveries:
    $3 for pharmacy, $10 for medical equipment

    Off-Island Deliveries:
    $3 for pharmacy, $20 for medical equipment in service area

    Outside of service area:
    Special Rate

  • Choosing yes below acknowledges and agrees to all of the above statements and conditions.
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