By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am offered a chair rental agreement, my chair rental agreement may be terminated at any time.
I also understand and agree that the terms and conditions of my chair rental agreement may be changed, with or without cause, and with or without notice, at any time by the company.