Wheelchair transport:

I want to place an order for wheelchair transport. I want a price request for wheelchair transport.

Name/Company*

Address*

Postcode / Town*

Phone/GSM*

E-mailaddress*

Type of wheelchair * Type of wheelchair * Manual Electric

Ride info

Selection menu: Selection menu: I wish a trip to / from a destination. I wish a ride to / from an airport.

Date*

Hour that we come to pick you up at the address? *

Number of persons*

Departure place (address) *

Destination (address) *

Date*

Hour that we come to pick you up at the address? *

Number of persons*

Departure place (address) / Name of departure airport *

Airport name / Arrival point (address) *

Flight number if known

Number of suitcases *

Are child seats desired? Are child seats desired? Yes No

How much? *

For what age?

I have knowledge of the terms and conditions + booking conditions *