Rental Pre Booking Form
Blue Badge Mobility.S.L Making your life easier in the sun
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indicates required fields
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NAME:
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ADDRESS:
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PASSPORT:
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PHONE NUMBER - HOME/HOLIDAY ACCOMMODATION:
MOBILITY SCOOTER:
CHOOSE TYPE
LARGE (MAXI)
MIDI (MIDI)
TRAVEL (MICRO 4)
WHEELCHAIR:
CHOOSE TYPE
SELF PROPELLED
TRANSIT
MWD ELECTRIC
POWER SE
HOIST:
CHOOSE TYPE
BED HOIST
STAND ASSIST
WALKING AIDS:
CHOOSE TYPE
WALKING STICK
CRUTCHES
4 WHEEL ROLLATER
2 WHEEL ROLLATER
BATHROOM PRODUCTS:
CHOOSE TYPE
SHOWER STOOL
TOILET RISER
TOILET SURROUND
DELIVERY ADDRESS:
DELIVERY TIME:
9.30
10.00
10.30
11.00
11.30
12.00
12.30
13.00
13.30
14.00
14.30
15.00
15.30
16.00
16.30
17.00
17.30
18.00
18.30
19.00
19.30
20.00
20.30
21.00
AIRPORT TRANSFER REQUIRED:
CHOOSE OPTION
NO
YES
FLIGHT NUMBER/ARRIVAL TIME:
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EXPERIENCED USER:
YES
NO
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WEIGHT OF USER:
SMALL UP TO 90KG
MEDIUM UP TO 110KG
LARGE UP TO 140KG
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DATE OF HIRE FROM & TO:
Please click on the Submit button to submit the form details.
TELEPHONE ; 0034 952967015, FAX 0034 952527827, GARY 0034 635445279, SARA 0034 635445279
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