Download completing an equipment order form

Equipment Order Form
Please complete this form to select the items you require to tailor your package and return
with your Client Information Record and Hire Agreement.
If you suffer with a disability or chronic illness you may be eligible for VAT exemption. To claim VAT exemption you
will need to complete the VAT exemption letter that is enclosed within your pack and return with this Equipment
Order Form.
To make working out the prices easier for you the prices below show one with VAT included and with VAT excluded,
choose the appropriate price list to work out your costings.
If you require help to complete this form please contact Ashford Lifeline on 01233 642095.
New Customer Equipment Requirements: Prices for 1st April 2016 – 31st March 2017
Hired Items
Annual Hire
Exc VAT
Annual Hire
Inc VAT
154.99
185.99
Mandatory Items
Price per Item
Exc VAT
Price per item
Inc VAT
Quantity
Total Cost per Item
Installation (within Kent)
30.00
36.00
x1
=0
Installation (outside Kent)
60.00
72.00
x1
=0
Safe Socket
21.49
25.79
x0
=0
Key Safe
73.50
88.20
x0
=0
Key Release Door Chain
58.99
70.79
x0
=0
Additional Pendant
49.99
59.99
x0
=0
Fall Detector
99.99
119.99
x0
=0
Smoke Alarm Detector
99.99
119.99
x0
=0
Carbon Monoxide Detector
114.99
137.99
x0
=0
Flood Detector
99.99
119.99
x0
=0
Pendant Easy Press
15.49
18.59
x0
=0
Lifeline Unit x 1
Pendant x 1
Payment Details
You will be invoiced separately for
these items after installation – do
not include this fee in your payment
Optional Items to tailor your package
=0
Cheques should be made payable to Ashford Borough Council
Name and address where items are to be installed:
Title: Title
First Name First Name
Surname
Surname
Address
Address
Post Code
Ref: LL5P F002
Post Code
Contact Number
v1
Contact Number
Proposed prices from 1st April 2016