north american non EU residents only

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Send us a reservation request-inquiry and we will get back to you with a speedy, affordable quote! or answer (usually within 72 hours or
less)
Your first Name *
Your Last Name *
Your Email Address *
the best phone number to reach you on. cell phone preffered. we'll send confirmation text etc. *
your home phone (optional)
check IN date *

MM		/
DD		/
YYYY
Check OUT date *

MM		/
DD		/
YYYY
the equipment rental dates
will be the same as above
unless otherwise specified.
 YES ( most pick this) 
 no ( please explain in the "special message" to us box below) 
please select desired equiptment *
 mobility scooter 
 manual push wheelchair  
 both  
 other ( please describe below in "special message to us" section 
WEIGHT of person using mobility equipment *
HEIGHT *
whats going on with the persons mobility ?
what is the name of town and or hotel -venue, etc you will be staying at ? or location you will be using services. *
Special Message to us
do you plan on transporting the scooter or wheelchair in a car?
 yes 
 no  
 unsure 
I agree with the service terms listed at busybeemobility.com
 no 
 yes 
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Busy Bee Mobility LLC
Mobility Scooter & Wheelchair Rentals
609-961-1233

Email: busybeemobility@gmail.com
terms and conditions at busybeemobility.com

C all rights reserved DC & Busy Bee Mobility LLC