Completing Your Quote Request*

*Note: This is only a quote request and NOT a reservation. To place a reservation you must call our office to check availability and schedule an appointment. Applicable sales tax and other fees such as shipping or out-of-area delivery are not included in this price estimate. Rentals require a damage deposit, refundable when equipment is returned damage-free.

Rentals

Scooter Type # of Weeks Price Per Week Deposit   Total
Free Spirit

 

Turning Leg Cady

 

Voyager

 

Delivery Options (Seattle Metropolitan area only)
Return Options (Seattle Metropolitan area only)

 
 

 

 
ESTIMATED RENTAL COST

           

Purchases
 

Scooter Type

Quantity

Purchase Price

    

Total
Free Spirit

Turning Leg Cady

Voyager

 
Delivery Options (Seattle Metropolitan area only)  

Return Options (Seattle Metropolitan area only)  

           
ESTIMATED PURCHASE AMOUNT    

         

CUSTOMER INFORMATION

Name:
Email Address (required field)
Telephone Number
Street Address
City
State
Zip
Is this the same as delivery address? Yes    No
Delivery Address (if different)  
Street Address
City
State
Zip
   
To assist us with the correct choice of scooter:
   
Briefly describe the injury, surgery or illness:
Right or Left Leg? Right  Left
Do you have a prescription? Yes    No
Height
Weight
Comments:
How did you find out about us?
If other, please explain