RENT TO OWN OPTION

Now, you can rent to own one of our professional quality breast pumps!  Simply fill in the information on this form, print it out,  and fax the signed copy to 877-909-7867 or mail to:   Lactation Connection, PO Box 265, Bluff Dale, TX 76433.  Questions?  Call 800-216-8151.  Return to Home Page.

Name:  Last, First & Spouse: 

Street Address:   

City:    State:    Zip: 

Drivers License State:          Number: 

Social Security Number:    

Email address:        

Credit Card #:  Exp. Date:  CVV Code:  

telephone#           work/mobile#

Your order will be processed without tax if you are outside Texas.  Texas residents add 6.75% unless you are faxing a doctor's prescription as indicated below.   $15 shipping fee will be added.  This will cover FedEx ground shipping as well a label that will be emailed to you for return shipping if you choose not to keep your pump.   This program is only available in the lower 48 states.

Rent-To-Own Program

Two month rental and kit purchase is required.   At the end of the two month period, you have the option to:  1) return the pump with no further obligation, 2) continue to rent the pump at $55 per month or 3) pay $109 to complete the rent to own program which entitles you to keep the pump complete with a three year manufacturer's warranty.  Note:  Purchase option is available at any time during your rental, but buy out price remains the same.  If you choose to return, rentals are considered on time if in transit by the due date.  Please call before your due date for your return label.

Indicate applicable rental and purchase items:     2 mo rental  of Hygeia EnJoye $110     

 double pumping collection kit  $39.99    cooler/carrier bag $49.99    car adapter $14.99

I am having my doctor fax a prescription for the breast pump to 877-909-7867 so I won't have to pay the 6.75% sales tax required for rentals in Texas. 

By signing below, I agree that the information provided is true and accurate and that I accept responsibility for the whereabouts of the equipment rented as well as the charges to my credit card for the initial rental and $55 per month thereafter unless I choose to purchase for a balance of $109 or return at the end of the two months.  I understand that this is a contract for the full term of the rental and that no refunds will be given for early return. 

Signature of lessee/cardholder:  

 

 

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