I,_______________________________________take full responsibility for the equipment named here;
_________________________________________________________________ and agree to return said
equipment in the condition in which I received it with consideration given to normal wear and tear from use such as but not limited to; minor scratches/scrapes, decreased tire tread, worn strapping, stripped screws, etc.
I also agree to assume full financial responsibility for repairs to the above named equipment in the event I
return it with damages other than normal wear and tear (cost to be determined after review and evaluation from
a professional specializing in bicycle repair.)
Furthermore, should I return the equipment in such a manner, as it is beyond repair I assume full financial
responsibility for the original cost of the equipment in the amount of $_______________ .
I agree to return the equipment at a specified time of I month or at such time as has been agreed upon
and listed by the parties below.
National Wheelcats Representative Loan Recipient Athlete Loan Recipient
Date equipment needs to returned
My address and phone numbers where I may be reached:
Name: __________________________ Work Phone: _________________
Cell Phone: ______________________ Home Phone: _________________
(City) _______________________ (State) _____ (Zip Code) _______________
E-Mail Address: ________________________________________________
Emergency Contact: ______________________________ Phone Number: __________________