Online Reservation Form

You can easily reserve your scooter by completing the following on-line reservation form, or contact us directly to set up your rental.

Each scooter rented requires its own reservation.

If for some reason you have any difficulty or would prefer to speak with us directly to make your reservation, please call toll free 1 (800) 820-3576 in the US or 1 (727) 816-9772.

Scooter Renter Name *
Person Name Holding Hotel/Accommodation Reservation where we will be delivering Scooter (*)
Street billing address of scooter renter credit card that will be used (*)
Home Phone
Cell Phone
Email Address (*)
How did you hear about our company
Where will you be staying in Tampa Bay area/where will we be delivering the scooter: Accommodation Name (*)
Phone No.
Please choose Equipment Needed (*)
Renters Arrival Date Into Tampa Bay Area Renters Approximate Arrival Time Into Tampa Bay Area
Date the client wants the scooter delivered to begin use/rental (*) Time the client wants the scooter delivered to begin use/rental (*)
  Hour: Minute:
Date the client wants the scooter picked up to end use/rental (*) Time the client wants the scooter picked up to end use/rental (*)
  Hour: Minute:
Mobility Products Weight Capacity Days Renting Cost
Delivery & Pick Up :
7% Sales Tax
Riders Height " (*) Riders Weight: lbs (*)
 "  lbs
Travel Agent's Email Address
Travel Agent's Code
Other important delivery and information
Credit Card being Used
Visa American Express
Master Card Discover
Credit Card Number (*)
Card Holders Name (*)
Expiration Date (*)
Security Code (*)
(The last three digits located on the signature strip on the back of your MasterCard, Visa or Discover card or the four digits above your card number on the front of your American Express)

I authorize the total rental Amount to be charged to the above credit card 24 hours before equipment rental begins. I understand I am fully responsible for the scooter during the rental period and any damage or loss incurred while in my possession.

I may cancel my rental and receive a full refund up to 12 hours prior to my arrival and must call in my cancellation to Scooter Direct – at toll free 1 (800) 987-6791 or for international callers to 1 (727) 816-9772

By checking this box, renter agrees to the Rental Agreement and Waiver of Liability and Hold Harmless Agreement

*you need to check the waiver of liability box before you can submit your reservation
Download a PDF copy of our Online Reservation Form
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