wheelchair Requests

Brand new wheelchairs are donated to you free of charge. The wheelchairs are paid for by public donations and profits from our shop.


Please complete & Submit the form below

By submitting a request for a wheelchair, you agree to our
terms and conditions.

Name *
Name
Phone *
Phone
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Enter in pounds. Only numerical values.
Instructions are pictured below.
Ship to Address *
Ship to Address
 

By submitting a request for a wheelchair, you agree to our terms and conditions.

 
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