* Renter Full Name
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*Phone Number
Phone Number Please check... Call __parser__boolean_attribute_value__parser__ Text
* Email
Email
Will you be transporting the scooter via airplane, bus or train?
Yes Please check...__parser__boolean_attribute_value__parser__ NoPlease check...__parser__boolean_attribute_value__parser__
Additional Instructions
I have read and agree to the terms of the Mobility Rentals and Repairs LLC.
Rental Agreement * Yes Yes
SendSend
We will contact you within 24 hours to discuss the details of your rental. An invoice will be sent to your email which you can pay online with credit card. We reserve our equipment based on a first in, first served basis. If you need it sooner than 24 hours please call 608 572 8708
Self Pickup Location: 2836 County Rd MM, Fitchburg, WI 53711 (by Appointment Only)
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Delivery/Pickup Fee in Dane County Wisconsin $45
Full Name__parser__boolean_attribute_value__parser__
Email Address
Rental Agreement *Yes Yes
We will contact you within 24 hours to discuss the details of your rental. An invoice will be sent to your email which you can pay online with a credit card. We reserve our equipment based on a first in, first served basis. If you need it sooner than 24 hours please call 608 572 8708
