We Also Offer a Full Line of Medical Equipment Rentals.
See our other site www.DiscountMobilityUSA.com for more information on our medical & handicap rentals.

Click To Download Our Medical Equipment Rental Form.

Click To Download Our Handicap Van Rental Form.

Class Vehicle Type Year Daily Weekly Monthly
Economy Accessible Mini Van (96-00) Higher mileage but well maintained $84.00 $525.00 CALL FOR RATES
Standard Accessible Mini Van (00-03) Medium Mileage $100.00 $588.00 CALL FOR RATES
Premium Accessible Mini Van (03-09) Late models low mileage $100.00 $588.00 CALL FOR RATES
Full Size Handicap Transport Van Late models $100.00 $630.00 CALL FOR RATES

 

Live Help

To request a handicap van rental quote please submit the following form.

We will contact you shortly with your customized quote.

For A Quote By Phone : 1 (866) 322-4400

Contact Information

 Mr. Mrs. Ms.

Renters Name (Required)
Address
City State Zip
Phone #
Preferred time of day to call:
Email  (Required)

Pickup & Return Information
(Monday-Saturday, 8:30am-4:00pm, We also deliver on Sundays & Odd Hours)

Pickup Location  
Dropoff Location  
     
Pickup Date  
Pickup Time  
     
Dropoff Date  
Dropoff Time  

Airline Travel Information

Arrival Airline
Arrival Time
Flight #
   
   
Departure Airline
Departure Time
Flight #

Driver's Insurance Information

Driver's Insurance Company        
Insurance Policy #        
Expiration Date:        
Insurance Agent's Name        
Insurance Agent's Phone # Area code: Prefix: Number:
Does Policy Cover Rental Vehicles? Yes No        

Driver Information   (As it appears on valid drivers license)

Primary Driver
Driver's License #
State Exp. DOB
Additional Driver
Driver's License #
State Exp. DOB

Local Address while staying in Florida

Hotel/Resident Name
Address
City State Zip
Local Phone # Area code: Prefix: Number:
Will the vehicle be driven outside of Florida?     Yes No  

Method of Payment

Visa Master Card

Disability Information

Please describe disability in order for use to assist with the correct transportation needs.

Accessibility Options
(Vehicles are not equipped to drive from a wheelchair. Driver must be able to use a transfer seat)

Total Number of passengers (including driver)    
Number of Passengers in Wheelchair/Scooter    
Passenger Seat Removed     Yes No
Hand Controls    Yes No
Wheelchair Scooter     
Manufacturer    Model        
Occupants height from ground to top of hair while sitting in wheelchair /scooter         
Other Special Needs        

Emergency Contact Information

Name
Relationship
Phone Area code: Prefix: Number:
   
   
Image Verification:

 Type the word exactly as it appears in the image to the right.
   

We Also Offer a Full Line of Medical Equipment Rentals, See our other site www.DiscountMobilityUSA.com for more information on our medical & handicap rentals.

 

Click Here To Download Our Medical Equipment Rental Form.

Click Here To Download Our Handicap Van Rental Form.


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