Electric Wheelchair Name First Last Email Contact NumberSelect Your Electric Wheelchair Type(Required)On Island UsageCruise Ship Usage Wheelers Number(Required)3 Wheeler4 WheelerRental Type(Required) Per day Per week Rental Type(Required) Per day Per week Price (per day) Quantity(Required) Price: $50.00 Quantity Price (per day) Quantity(Required) Price: $75.00 Quantity Price (per week) Quantity(Required) Price: $300.00 Quantity Price (per week) Quantity(Required) Price: $350.00 Quantity Total Choose a Date MM slash DD slash YYYY CAPTCHA
