Your Full Name: * Home Address No. / Street: * Suburb / City: * State: * Postcode: * Phone Number: * Email Address: * Rider's Weight Range: * <75kg76kg - 90kg90kg - 100kg100kg - 110kg110kg - 120kg120kg - 130kg130kg - 140kg140kg - 150kg>150kg Rider's Height Range: * Short < 160cm (< 5ft 3)Medium 160cm - 170cm (5ft 3 - 5ft 7)Tall 170cm - 180cm (5ft 7 - 5ft 10)Giant 180cm + (> 5ft 10) Scooter / Device of Interest: * If you're hiring a Electric Wheelchair. Which side do you need the joystick controller to be on? —Please choose an option—LeftRightNot hiring an electric wheelchair Accessories: NoneRear Shopping Bag - $5.00 p/wkSun Roof - from $7.50 p/wkCup Holder - $1.50 p/wkCushion - Varies p/wkCover - $5.50 p/wkCover - $5.50 p/wkRamp - from $4.00 - 15.00 p/wkPoncho - $1.00 p/wkBath / Shower Handle or Chair- from $1.00 p/wk Delivery / Start Date: * Return / End Date: * Delivery / Collection Address: * —Please choose an option—Store Pickup/Return in MELBOURNE:Store Pickup/Return in PHILLIP ISLAND:Store Pickup/Return in GREATER GEELONG: Not Available yet. Coming Soon!DELIVERED / COLLECTED from your Address in METRO MELBOURNE:DELIVERED to your Address in PHILLIP ISLAND:DELIVERED to your Address in GREATER GEELONG: Not Available yet. Coming Soon! Please NOTE : 1.Collection or Hire Return at the Melbourne Branch is between 9:30am – 3:30pm MONDAY to FRIDAY. 2.You do not need to let us know the exact time you are coming, but we do prefer times between 9:30am – 11:00am or 1:30pm – 3:30pm Mobility Scooters for Hire Sale Service - METRO MELBOURNE Factory 25 | 58 Mahoneys Road, Thomastown VIC 3074 (03) 7036 4440 Please NOTE : 1.COLLECTION or Hire Return at the Philip Island Store is only available on WEDNESDAY Evenings, SATURDAY or SUNDAY, and this is by Appointment ONLY 2.A Staff Member will confirm the pickup and return times with you. Mobility Scooters for Hire Sale Service – PHILLIP ISLAND 11 Maroubra Dr, Cape Woolamai VIC 3925 +61 457 533 432 Please NOTE : This service is not yet available Please NOTE : 1.Drivers deliver between MONDAY to FRIDAY ONLY. 2.Please be available between 10am-3:30pm on your Delivery day and again on your END DATE for collection. 3.We do not deliver to Airbnbs, Airports or Cruise Ships 4.If we are delivering to a hotel, please ensure your hotel approvals the hire device being delivered prior to your check-in, and please provide the Hotel Booking Number to us. Delivery / Collection address* Please NOTE : 1.Delivery or Collection is only available on WEDNESDAY Evenings, SATURDAY or SUNDAY. 2.If you are staying in a hotel, please ensure your hotel approvals the hire device being delivered 1-2 days before check in, and please provide the Hotel Booking Number to us. 3.We do not deliver to Airbnbs, or areas outside of Phillip Island and San Remo. 4.If you are a resident of Phillip Island, the Driver will confirm a delivery time with you.. Delivery / Collection address* Please NOTE : This service is not yet available Insurance Cover: * —Please choose an option—All Damage - Electrical Devices ($12.50 per week)All Damage - Mechanical Devices ($3.50 per week) Preferred Method of Payment: * Cash on Pickup (Not Deliveries)Credit / Debit CardEFTPOS (at Office)Bank Transfer How did you find us?: * Your Message: * << I confirm I have or will read all of the user manual of the device I intend to use and understand the information and that I will follow the instructions given. * << I confirm I will / have read and understand the Rental Terms & Conditions and that I will look after the mobility device I am hiring to the best of my abilities.
