Both Locations
Open Mon-Fri 10AM-5PM
704-821-7777
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Walkers/Rollators
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RENTALS
RENTAL FORM
LIFTCHAIR RECLINER RENTALS
RENTAL AGREEMENT
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Zinger & Zoomer
LiteRider Envy
iRide Mobility Scooter
EZ Ride
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iWalk3.0 Crutch Alternative
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UP WALKER
Twilight Lift Chair Recliner
Stander
Step2Bed
Pneumatic Compression Devices
Portable Oxygen Concentrator
SCHEDULE A VISIT
VIRTUAL CONSULT
RENTAL REQUEST
SERVICE REQUEST
DME ORDERS
Rental Process
Please keep in mind when requesting a rental that we only deliver on Tuesdays, Thursdays, and Fridays.
Rental Reservation Request
What would you like to rent?
Select Item #1
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What would you like to rent?
Select Item #2
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What would you like to rent?
Select Item #3
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Name of person using the equipment?
Reservation Start Date Request
Reservation End Date Request
Pick-Up or Delivery?
Pick Up or Delivery
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Email (we will email you a reservation confirmation once approved)
Cell Phone #
Home Phone #
Delivery Address (If item is being picking up from our store, than billing zipcode is only required)
City
State
Zip
How many steps to enter home?
Number of Steps?
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1st or 2nd Floor Delivery?
Enter 1st or 2nd
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Approximate Height of person using the equipment?
Approximate Weight of person using the equipment?
Credit card required for rental - Your credit card will not be charged until the day of rental.
Mobility & More Consultant
Who are you working with?
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How did you hear about us?
Google, Doctor, Friend, etc?
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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
Submit
We will contact you ASAP to confirm your reservation.Thank you!
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.
Rental Prices Click Here
Office/Fax:
704-821-7777
After Hours If Urgent:
704-280-0011
Email:
info@Mobility-More.com
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