Scootaround Cruise Rental Request Form

For equipment rentals that you will use at a cruise, 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.

The fields in bold are required unless indicated otherwise.
Personal Information
First Name
Last Name
Street Address
City
Country State / Province	Select... - - - - - - USA - - - - - - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming - - - - CANADA - - - - Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon - - - - - - - - - - - - - - - - Other Country
Other Country
ZIP / Postal
Your Height
Your Weight
Contact Information
Area Code + Phone
Area Code + Work Phone
Email Address
Rental Information
Equipment Type Equipment types shown here are examples only and may vary based on your location. Scooter Wheelchair Powerchair
Deliver Rental To	Cruiseship Hotel
Cruiseline & Ship Name
Cruise Port
Accessible Cabin? (Yes or No)
Date Needed From
While Scootaround will make every effort to accommodate all needs, you are encouraged to reserve in advance whenever possible. As such, web-based inquiries that are submitted on weekends, for certain delivery areas, may only be available as early as the immediate Tuesday.
Date Needed To
Hotel Guest Information
Name Registered Under (put "none" if you do not have)
Hotel Name
Room Number
Guest Arrival Date
Guest Departure Date
Special Needs or Concerns