Gestalt New York 614 Warren Street, Hudson NY 12534 · 646-389-4177 Product Loan Agreement Borrower information Name Company Address Email Phone Date of loan Due back by Loaned items Qty SKU Description Unit price Ext. price Subtotal $0 Sales tax — Total retail value $0 Condition before loan Noted by Gestalt New York Condition Good — no visible damage Loan agreement Gestalt New York is loaning the above merchandise to the borrower named above. All items must be returned to Gestalt New York, 614 Warren Street, Hudson, NY 12534 by the due date noted above. Only items returned in original loan condition will be accepted. Any imperfections must be noted and approved by Gestalt New York before items leave the showroom. Gestalt New York will retain a credit card number from the borrower in exchange for loaned merchandise. If merchandise is not returned by the agreed date and in original condition, Gestalt New York reserves the right to charge the credit card the full retail price listed above. Signature Clear signature Print name Full name Today's date March 27, 2026 Credit card (last 4) 0000 I have read and agree to the loan agreement above. I understand that failure to return items in original condition by the due date may result in a charge to my credit card for the full retail value. Submit loan agreement
