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Name
First Name
Last Name
Email
example@example.com
Phone number (mobile if possible)
product user weight
Product required
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Small mobility scooter
From 22 euros per day
€170.00
€
170.00
Quantity
1
2
3
4
5
6
7
8
9
10
rental period
1 week
2 week
Medium mobility scooter
From 27 euros per day
€205.00
€
205.00
Quantity
1
2
3
4
5
6
7
8
9
10
rental period
1 week
2 weeks
Large mobility scooter
From 29 per day
€219.00
€
219.00
Quantity
1
2
3
4
5
6
7
8
9
10
rental period
1 week
2 week
For wheelchair, powerchair and shorter rental period requests please use this box to tell us your requirements.
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.
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