Mobility Scooters in Hailsham, Mobility Companies in East Sussex
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Equipment Hire Agreement & Booking Form
Your details
Full Name
Contact #
Email
Will you require delivery:
Yes
No
Delivery address
Address 1
Address 2
Postcode
Town
Will you require collection:
Yes
No
Collection address
Address 1
Address 2
Postcode
Town
Type of Equipment for Hire
Please Select
Standard Wheelchair
Premium Wheelchair
Heavy Duty Wheelchair
Powered wheelchair
Portable mobility Scooter
4mph Mobility Scoter
Walkers and Crutches
Rollators
Date Required:
Time:
Date Returned:
Time:
Declaration / Terms and Conditions
I declare that I, the person hiring the above equipment can claim VAT Exemption
I Agree to
AJ Mobility Hire's Terms of Hire