Scootaround Rental Request Form

Wheelchair and Scooter rentals at your eventFor information about equipment rentals at your event, please complete this request form. Once we receive your rental request, a Scootaround representative will forward you a detailed quote directly to your 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
Country State / Province
Other Country
ZIP / Postal
Equipment User's Height
Equipment User's Weight
Contact Information
Please provide both your telephone and e-mail address so we may respond in the quickest method possible:
Area Code + Phone
Area Code + Work Phone
Email Address
Rental Information
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
All rentals must be confirmed!