Sydney Wheelchair Hire Quotation Form

Sydney Wheelchair Hire Quotation Form

Roland Priestley Mobility Centre, Hornsby NSW, Sydney Australia
Name*

First NameLast Name
Email*
example@example.com
Pick up date (Weekdays only)*
Roland Priestley Mobility Centre Hornsby
Return date (Weekdays only)*
Roland Priestley Mobility Centre Hornsby
Standard Self Propelling Wheelchair (Max load 100 kgs)Standard Transit Wheelchair (Max load 100 kgs)Large Bariatric Heavy Duty Self Propelling Wheelchair (Max load 160 kgs)Large Bariatric Heavy Duty Transit Wheelchair (Max load 180 kgs)
Left Side Elevating Leg RestRight Side Elevating Leg Rest
Upon Submission of this form we shall reply via email within 1-2 business days with your quotation. If the wheelchair hire is in less than 2 days please call us on +612 94824893 for the quotation.
Please verify that you are human*
Should be Empty: