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For wheelchair, powerchair and shorter rental period requests please use this box to tell us your requirements.
Name
First Name
Last Name
Email
example@example.com
Telephone number (mobile if possible)
product user weight
Date and time for scooter delivery
Date and time for scooter collection
Delivery address (please just fill as much as you know)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any additional info we may require.
Please be aware, all bookings require a 40 Euro deposit, this is taken on delivery of the scooter to you.
No booking is confirmed untill we have contacted you via email and sent a booking confirmation.
My Products
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Small mobility scooter
prices include free delivery and collection
€99.00
€
99.00
Quantity
1
2
3
4
5
6
7
8
9
10
rental period
1 week
2 week
other duration ( please use box below)
Medium mobility scooter
Prices include free delivery and collection
€109.00
€
109.00
Quantity
1
2
3
4
5
6
7
8
9
10
rental period
1 week
2 weeks
other duration ( please use box below)
Large mobility scooter
Prices include free delivery and collection
€119.00
€
119.00
Quantity
1
2
3
4
5
6
7
8
9
10
rental period
1 week
2 week
Other dureation ( please use box below)
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