Equipment Rental Request

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Equipment Rental Request

NOTE: EQUIPMENT REQUESTS MUST BE SUBMITTED AT LEAST 4 DAYS BEFORE DESIRED DATE.

Please fill out the form below and our mobility equipment partner will get back to you as soon as possible to confirm equipment availability and pricing.

Name for equipment reservation (first and last) *

Your Email (Note: be sure to check your spam folder for our response) *

Your Phone Number (including Country Code) *

What type of equipment would you like to rent? *

If other, please specify

Are there any specific features that the equipment must have?

What is the height and weight of the equipment user? (approximate is OK) *

What city would you like the equipment delivered to?

Please give the date and time of day you would like the equipment delivered? * NOTE: EQUIPMENT MUST BE REQUESTED AT LEAST 4 DAYS IN ADVANCE. *

What city would you like the equipment picked up from?

Please give the date and time of day you would like the equipment picked up? *

Are you staying in a hotel, apartment, or other? *

Hotel

Apartment

Other

Please provide the address and name (if applicable) of where you will be staying *

Travel Agent?

I am a travel agent

I am not a travel agent

Is there anything else you think we should know?

Would you also be interested in accessible transportation, accessible guided tours, and/or accessible hotel recommendations?

If you are human, leave this field blank.

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