Scootaround Rental Inquiry Form

Please complete this inquiry form for New York City wheelchair and scooter wheelchair rentals. We will forward you a detailed quote directly to your e-mail Inbox!

Or Click Here to return to our main rental page.

• Fields marked with * are optional.
• This is not a booking form -- all rentals must be confirmed.

Personal Information
First Name
Last Name
Street Address
City
Country State / Province
Other Country
ZIP / Postal
Your Height
Your Weight
Preferred Contact Method
Contact me by:
Please provide both your telephone and e-mail address in case we cannot reach you at your preferred method		 Telephone E-mail
Area Code + Phone
*Area Code + Work Phone
Email Address
Rental Information
Deliver Rental To Convention Hotel
Destination City
Destination Address
Date Needed From
Date Needed To
Hotel Guest Information
Name Registered Under
*Hotel Name
*Room Number
*Guest Arrival Date
*Guest Departure Date
Special Needs or Concerns
This is not a booking form
All rentals must be confirmed!