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
Equipment User's Height
Equipment User's 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
Equipment Type
Equipment types shown here are examples only and may vary based on your location.
Scooter
Wheelchair
   
Deliver Rental To
My Convention/Event My 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!