TheBumpWA BIRTHING TENS HIRE AGREEMENT
Title
First Name
Surname
Address
Suburb
Landline
Postcode
Mobile
Email
Hire Equipment and Period
Period of
Hire
From:
To:
Value $
75.00
Returnable Deposit $
50.00
Total Cost $
125.00
Budget Pack Contains
1 Neurotrac-TENS machine, 1 set of 100x50 pads (new)
Extension of Hire
The period of hire is usually 5 weeks – additional weeks are charged at $15.00 per week.
Acceptance of Terms
I accept and understand the terms and conditions of hire, as stated in the conditions
attached.
_______________________________________ Hirer’s Signature
Payment Details - I authorise TheBumpWA to debit by credit card for hire, damage or loss of
equipment and accessories.
Cash
Cheque Please make cheques payable to: TheBumpWA
Credit Card  Mastercard
Card No
Expiry:
/
 Bankcard
 Visa
CCV last 3 number on back of card
Name of Card Holder:
________________________________
Signature of Card Holder:
________________________________
TheBumpWA BIRTH TENS MACHINE HIRE
As a fundraiser for TheBumpWA, we now to hire out Neurotrac-TENS machines to help mothers manage
to intensity of contractions in the earlier stages of labour. It provides a mobile, drug free pain
management tool, with personal control over your pain relief.
When you hire a tens machine from us, you support our work in ensuring that all women’s choices in
childbirth are safe, respectful and empowered.
TENS stands for Transcutaneous Electrical Nerve Stimulation, and has successfully been used for many
years by pregnant women and professional midwives worldwide to treat labour pain.
How does Neurotrac-TENS work?
The machine works by stimulating your body’s own natural defences against pain.
The pads are positioned on your back. These gentle impulses attack pain in two ways:
1. By stimulating the release of endorphins, the body’s own pain relieving hormones.
2. By stimulating the nerves to block pain signals before they reach the brain.
The Advantages
• Allows you to move around and stay mobile
• No effect on the baby
• User friendly
• Non addictive
• Safe to use at home
• Non invasive
• Pain control without drugs
Package:
Neurotrac-TENS Machine and 1 set of 4 pads for 5 week period is $75.00
A deposit of $50.00 will also be charged and refunded upon return of the unit.
Neurotrac-TENS is not to be used in water.
The price is pick up – postage costs $13.00, one way, registered post.
Our TENS machine comes to you clean, sanitised and ready to use with 1 new set of pads, additional
pads can be purchased for $25.00.
The machine can be used at home or in hospital.
We take great pride in ensuring our customers are completely satisfied with the condition and standard of
our tens machines and our friendly efficient service. Nothing but the best for you and your baby.
Important Terms and Conditions:
Advance Bookings Essential.
 Our hire agreement is for a five week rental period.
 There is no refund if you don't end up using the machine.
 Booking cancellations incur a $20 administration fee which is deducted
from the $50 deposit.
 Your deposit is refunded on return of the machine if it is on time, in good
condition with all accessories included. The refund will be credited to your
account approx 1 week from the date of return.
To book a Neurotrac -TENS, fill in the Hire Agreement form and return to
Sue Clark at TheBumpWA on E: admin@thebumpwa.org.au F: 9430 6068 T: 9430 6882