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Clearwater Beach Florida - 727-519-3008

Reservation Request Form: Please complete this form or call 727-519-3008.

Once we have your information we will call you to confirm your reservation and collect the required deposit. Your deposit will apply toward your rental fee. (see below)

Name    
Address    
City State Zip
Phone    
Item Beach Wheelchair   Wheelchair Handi-cap Scooter 
Other    
Dates: From: To:    
 
Customer Pickup Time:
AM PM (Pickup hours are 10AM to 5 PM daily)
  Customer Return Time: AM PM (Call to Confirm 727-519-3008)
  Delivery Drop Off Time: AM PM
  Return Pickup Time: AM PM (Call to Confirm 727-519-3008)
Deliver To:    
Name   Phone: 
Address    
City State Zip

Deposit: $50.00 non-refundable deposit is required to reserve. This can be paid on Pay Pal after we confirm your reservation or you can call 727-519-3008 to give us your credit card number.

Reservation Form