I agree to execute the following documents and/or identified categories of documents as an electronic signature (e-signature) as necessary to process the beneficiary's medical equipment or supplies order. The documents subject to this consent include, but are not limited to, the Medical Release, Consent to Process, Delivery Ticket and associated delivery documents, and all subject delivery and terms and conditions of acceptance documents. All electronically signed documents are stored and found in the Customer Access Portal. A hard copy is available upon request.

Disclosure:
By typing your name and clicking the "Submit Electronic Signature" button, you are signing electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature. By clicking "Submit Electronic Signature" using any device, means or action, you consent to the legally binding terms and conditions of this Document. You further agree that your use of a keypad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide the Company, or in accessing or making any transaction regarding any agreement, acknowledgment, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You further agree that your signature (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and . You are also confirming that you are the individual authorized to enter into this Agreement.