Contact - B-Town Mobility Scooter Rentals

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Name

First

Last

Address

What is *your* home address?

Phone Number

May we contact you via text message regarding your booking?

Yes
No

A member of our staff will reach out to confirm your rental.

Email

Preferred Method of Contact

Phone
Email

A member of our staff will reach out to confirm your rental.

Requested Rental Dates

Please use MM/DD/YYYY - MM/DD/YYYY format.

Rider Weight

Please use lbs. Can be an approximation.

text Comment Scooter

Would you prefer a three-wheeled or four-wheeled scooter?

Three-Wheeled
Four-Wheeled
No preference

We will do our best to accommodate your preference, based on our available inventory. Rental prices are the same regardless of number of wheels on the scooter.

Scooter Delivery Address

Where should we bring your rental scooter?

Scooter Delivery Time

What time should we bring your rental scooter? Our delivery hours are 7 AM - 7 PM, Monday - Sunday.

Scooter Pickup Address

Where should we pick up your rental scooter at the end of the rental period?

Scooter Pickup Time

What time should we pick up your rental scooter at the end of the rental period? Our pickup hours are 7 AM - 7 PM, Monday - Sunday.

Comment or Message