Mobility Rentals information request form

Thank you for your your interest in our service.

Please note that our prices EXclude VAT as, in most cases, VAT is not payable if you are registered as disabled.

Our fully inclusive service covers London and the following counties:
Bedfordshire
Berkshire
Buckinghamshire
Cambridgeshire
Essex
Hertfordshire
Kent
Northamptonshire
Oxfordshire
Surrey.

Please complete the boxes and click on the submit button

Name
Email Address
Telephone Number(s)
Postal Address
Post Code ... ... ... ... I am interested in: ... Rental ... Purchase
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...single item .multiple items
........... scooters ...power-chairs ...beds ...hoists ...bath-lifts
Other enquiry/comment:

If you found this site via a Search Engine (e.g. Google, Yahoo, MSN) please state which one:
If you found this site via another site, please advise the name of the site, if known:
If you knew about this site and entered the name directly into your browser, please advise the source of your information (e.g. leaflet, referral from friend/existing client), if known:

Thank you for completing this form. To send, please click on this button >

Please note that some systems, such as AOL, will not copy completed form information into an email, therefore please email us with details as requested above. Thank you.

feedback @ mobilityrentals.org.uk