Mobility & More | Rental Form | Senior Care Products

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SALES | SERVICE | RENTALS

Call Us: 704-821-7777

Email Us: info@Mobility-More.com

SCHEDULE A VISIT

SERVICE REQUEST

Rental Process

Rental Reservation Request Form

Name of person using the equipment?

Reservation Start Date Request

Reservation End Date Request

Email (we will email you a reservation confirmation once approved)

Cell Phone #

Home Phone #

Delivery Address

City

State

Zip

Approximate Height of person using the equipment?

Approximate Weight of person using the equipment?

Credit card is required for rental - A $100 deposit will be charged to reserve your rental. Balance is due day of pick up or delivery.

Please add any additional information you would like for us to know about your rental reservation.

Please accept terms & conditions after reviewing our Rental Agreement

Complete the rental reservation details and submit form.

We will contact you ASAP to confirm your rental reservation.

Please feel free to call or email us for more information or if you have any questions regarding your reservation.

For Rental Prices Click Here
For Liftchair Rental Information Click Here

Office/Fax: 704-821-7777
(yes, our fax number is the same as our office number)
Please call or text our after-hours number if urgent: 704-280-0011
Email: info@Mobility-More.com

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