RESERVE A BEACH WHEELCHAIR

Beach wheelchair requests require a minimum 24-hour notice. Once you’ve complete the request form below, a member of our team will reach out to you to confirm your reservation along with any additional instructions to help with your request. Thank you!

Please complete the form below

Name

First Name

Last Name

Phone

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

License State & Number

Date Needed

YYYY

Pick Up or Drop Off

If Drop Off...

Additional Notes