Wheelchair and Scooter rentals at your eventScootaround Rental Request Form

For equipment rentals that you will use at a convention, meeting, outdoor venue or other event, please complete this request form. Once we receive your rental request, a Scootaround operator will forward you a detailed quote online directly to your e-mail Inbox!

• Fields marked in Bold are required.
• 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!