INDEPENDENT MOBILITY

Reservation Form

(Privacy policy)

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Pickup Date  *

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Return Date  *

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Item Type  * Scooter  Power Chair  Wheel Chair  Lift Chair  Other (please specify in message) 

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Name  *

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E-Mail Address  *

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Phone  *

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Message

   

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Rental Information

To check availability and reserve your rental today you can use the online reservation form or call customer service directly at 877-972-6683. If you submit your reservation via the online form we will contact you to confirm your reservation.

Independent Mobility will deliver rental items, free of charge, to locations within 20 miles of our facility in Pittsfield, Ma. Rentals for destinations outside of our local delivery area are subject to additional charges. Please call customer service at 877-972-6683 for details.