*PLEASE READ CAREFULLY BEFORE SIGNING*

DELIVERY CHECKLIST

____HELMET

____QUICK RELEASE MECHANISMS

____BRAKES AND GEAR MECHANISMS

____LAW AND LOCAL ORDINANCES

____TIRE PRESSURE

I, for myself and any minor children for which I am parent, legal guardian or otherwise responsible, release Rock n' Road Cyclery, agents, and employees from any liability for damage or injury to myself or any person or property resulting from negligence, adjustment, selection and use of this equipment. I, understanding the inherent risk involved in using the equipment, accept the full responsibility for any and all such damage or injury which may result.

I accept the use, as is, the equipment in good condition and accept the full responsibility for care of equipment while in my possession. I will be responsible for the prompt replacement at full retail value of all rental equipment not returned or damaged, other than reasonable wear and tear, which results from the use of this equipment.

I agree to return rental equipment by agreed date in clean condition to avoid additional charges.

All instructions on the use of rental equipment have been made clear to me and I understand the function of the equipment.

I accept the terms of this agreement and accept responsibility for the above charges.

SIGNATURE:_____________________________________   DATE OUT__________________DATE IN__________________

PLEASE RETAIN THIS COPY FOR CREDIT TOWARDS A NEW BIKE PURCHASE OF RETAIL VALUE $2000 OR MORE WITHIN 180 DAYS OF RECEIPT DATE.