MobilityFound.org -- New Client Questionnaire

Name

First NameLast Name

Address (city, state and zip are required, street address is optional)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email (either an email address or a phone number is required)

example@example.com

Phone Number (we prefer both an email and a phone number, thanks).

Please enter a valid phone number.

What is your level of physical functionality?

1) Limited use of legs (can move in and out of a chair un-assisted).2) No use of legs, must remain in chair but have full use of both arms / hands.3) No use of legs, must remain in chair and have full use of right arm / hand only.4) No use of legs, must remain in chair and have full use of left arm / hand only.Other, please explain below:

If "other" is selected, please indicate your response here:

Where you plan to use this vehicle, is it an urban area with slow moving traffic? Please provide some background:

Completely slow moving urban, such as inner-city, New York, Boston, Washington DC, etc..Some rural routes but low speed travel (secondary local roads, etc)..Highway travel is required in my areaOther, please explain below:

If "other" is selected, please indicate your response here:

Each state has rules which govern the maximum speed which these vehicles can travel. Most states have a 40-MPH limit but this sometimes can vary and it can even change from time-to-time. Such vehicles are not intended for highway travel, which is usually defined as above 45-MPH (minimum).

Please indicate which of the models shown are most interesting to you. (Pick as many as apply).

512 (four door--four wheels--no passenger seat or one passenger seat option)511 (two door--four wheels--no passengers)112 (four door--three wheels--can seat up to three passengers)112 PU (two door--three wheels with pickup bed in rear--can seat up to three passengers)

Which options would be most interesting to you?

Air Conditioning *** see details belowBattery heaterLong range lithium battery pack

*** Engineering electric vehicles is similar to engineering aircraft. Weight is a big issue and batteries weigh a lot. For air conditioning, the maximum capacity lithium battery option is required.

Battery heaters are used in cold climates but only work when the vehicle is plugged in. The heater is not necessary with the Lead-Silicon battery option. However, this type of battery does not provide enough capacity to run air conditioning. All of these options will be explained in further detail after this contact form is submitted.

Driver's license status

I have a driver's licenseI do not have a driver's license but should not have a problem obtaining one.I do not think I can ever get a driver's license

Some states may not require driver's licenses for these types of vehicles. We will do our best to get to the bottom of these issues and report them to you. When it comes to individual state's regulations, we can only do our best job of ascertaining the necessary information but we can not guarantee that it is exactly accurate. We will also provide you with the contact information in your own state which we used to obtain the information we are reporting. The ultimate responcibility to insure compliance with local requirements would be on the client. However, there are a couple of other methods available to register such a vehicle, even if your home state won't cooperate. These are expensive and require a lot more time to do. We would advise you of all such options when we reply to your submitted questionnaire.

This encripted form will come only to The Mobility Foundation for review. We will need up to a week to answer you. If you provided an email, we will answer by email. If you provided a phone number but no email, we will send you a link by text to see our response. If your phone can not use texts, please provide an email address. From that point we will provide you with the contact for the manufacturer(s) in the USA. If you require further assistance, we can (upon your request) submit the material to the manufacturers on your behalf and they will contact you.

After forwarding you the brochure(s) and our report, should we destroy your file?

No, retain indefinitely in confidence.Destroy your files as soon as we provide you with the catalogs and your report.Destroy after 3-months

Please provide any other notes or information you wish to convey here:

No one from our office will contact you, except, if we have a question relating to your answers, or, if you ask us to contact you.

This version was posted 01-2024 and is subject to periodic updates without notice.

MobilityFound.org

Terms and conditions of use:

1. The Mobility Foundation (“TMF”) does not sell anything. Any transactions would be with the manufacturers in the USA. We are providing a free service to benefit disabled people.

It should also be said that some of this technology is relatively new. Each state sets its rules as to what they will issue a license plate on. Some states do not require driver’s licenses to operate these, while other states will. We assist the “client” by researching these issues before we reply to the completed questionnaire. Think of us as a free concierge service for disabled people.

Our information may be imperfect or, your state’s rules may change from one month to the other. In addition to reporting on your state’s rules, we will also provide the state contact information which we used to arrive at our conclusion(s). We strongly encourage the client to double-check our information themselves as far as your own state’s regulations, before finalizing any purchase with the manufacturer. Again as before, rule #1 covers this.

Generally speaking, driver’s liability insurance would be available and some states will require it. If it’s a requirement, chances are high that it is going to be available and relatively cheap too. If it is not required, who knows? We can not check this on your behalf. What we can do is inform you if insurance is required by law and provide you with some basic guidance on how to describe the vehicle to your local insurance agent, along with vehicle specifications. Photos will probably be necessary and we will provide reference photos for you . Our job is to make it as easy for you as possible. You’ve had a hard life, now it gets easier.

2. The Mobility Foundation (“TMF”) is a non-profit corporation, similar to a co-op, chartered in the state of Wyoming. We are not an IRS designated charity and we do not ask for donations but if someone wants to help us with a donation, it would not be tax deductible.

Being a not-for-profit corporation simply means is that we can not have any “profits” at the end of each year. There are other guidelines involving how any money is spent, so It should also be disclosed as to what any possible revenue could be used for. General operating expenses, including possible labor costs. Professional expenses such as accountants, etc.. In the event that someone donated a lot of money , that which we could not possibly use for general operations, we would probably utilize the excess to subsidize the cost of the equipment to the disabled clients, or maybe even pay for their units entirely.

The user agrees to hold the Mobility Foundation and its management and staff free from liability of any type whatsoever. Any possible action filed against TMF or its representitive(s) would be automatically deemed as frivolous and the plaintiff would be responsible for reimbursement of reasonable legal costs incurred by TMF to process and dispose of any such action. The day-to-day by-laws of this non-profit are set by its board members and these are available upon written request by emailing: Manager@MobilityFound.org

This Agreement is to be construed using the state laws of Wyoming, with Wyoming as the legal venue.

Privacy:

We will not share your information with anyone, without your further specific authorization to do so. Generally there would be no need for that, until you were ready to place an order with the manufacturer. In that instance, you could contact the recommended manufacturer(s) yourself or authorize us to give the manufacturer(s) your phone or email. We would be mostly done with our job at that point.

Contact us:

Mobility Foundation

30 North Gould Street - Suite “R”

Sheridan, WY 82801

307 225-7770

Manager@MobilityFound.org

If you have one or two questions, email may be the best method. For an extensive conversation, please email a request for a phone conference, with three choices of times and dates.

This version was posted 01-2024 and is subject to periodic updates without notice.