Standard Lightweight Transport Wheelchair Booking Form

Standard Lightweight Transport Wheelchair Booking Form -2

Where are you staying at?

What is the exact name and the address of the Hotel or the Vacation Rental you will be staying at?

Specify Address

Address of Residence

Address of Military/Family

Is pickup and delivery the same address?

Yes

If No, what is the other address?

Specify Other Address

May I have the name of the person on the reservation at Hotel?

If you do not have it at this time understand we will need it for your free delivery to your hotel.

Height of the person using the equipment?

How many? (Wheelchairs to rent)

Does that person know how to operate a wheelchair?

Yes

Unsure

Referral Hotel (Optional)

Weight of the person using the equipment?

Does he or she own a wheelchair?

Yes

Unsure

How did you hear about U-Go Mobility?

Referral Name

Please provide information if you have it this time.

What is your airlines and flight number?

Flight Arrival Date and Time

Flight Departure Date and Time

Requested Date of Delivery

Requested Time of Delivery

Requested delivery time is subject for approval and could be adjusted by the driver 30mins either way. For other delivery schedule request, please indicate on Special Request Box provided below.

Requested Date of Pickup

Requested Time of Pickup

Requested pick-up time is subject for approval and could be adjusted by the driver 30mins either way. For other pick-up schedule request, please indicate on Special Request Box provided below.

Special Requests

IMPORTANT:
We noticed that your arrival is within 3days. We want to ensure we can meet your delivery expectations on this last minute reservation. Most of our reservations are submitted months ahead of time. Please call (855) 456-4846 during Hawaii business hours to coordinate and we will do everything possible to fit you in our schedule.

IMPORTANT:
Due to your request being less than a 4-day rental, we will need to take special care of your order to ensure you get exactly what’s best for you to accomplish what you want to do on your trip.

Please submit the special inquiry page -> https://ugomobility.com/inquiry/ and someone will get back to you in an email or phone within 24 business hours.

Or you’re welcome to call (855) 456-4846 and talk to us directly during Hawaii business hours.

REMINDER: Kindly check all the dates provided prior to order submission. Mahalo

Transport Wheelchair

Specifications:

Weekly Rate: $98.00

Book Early, Free Delivery

Our Honolulu Location:

UGo Mobility Scooter and
Wheelchair Rental Service

1130 N Nimitz Hwy, Honolulu, HI 96817

Phone: (855) 456-4846

Wheelchair or Mobility Scooter? Which is right for you?