Equipment Order & Reservation

Aloha!

Please simply provide us your information in advance so we can have your equipment readily available for pick up or delivery.

For safety reasons and company policy, Kauai Wheelchair and A1 Lift LLC members are not permitted to assist equipment users into or out of wheelchairs or scooters. They are also prohibited in providing assistance with swimming, dressing, toileting, or other tasks. Non-Ambulatory Passengers must have adult supervision during transportation. Thank you for your understanding.

Mahalo's

Kauai Wheelchair Staff

Your form message has been successfully sent.

You have entered the following data:

Mobility Equipment Reservation & Scheduling Form

Please correct your input in the following fields:

Error while sending the form. Please try again later.

Name/Renter *

Contact # On Kauai *

Equipment Request & User Weight *

Kauai Hotel or Address *

Rental Period *

Start Rental Time *

Stop Rental Time *

Renter's Home Address & Email *

Payment Major Credit Card or Venmo

Electronic Payments includes 4.7% Local Tax & 3.5% Transaction Fee

Acknowledge Cancellation/Refund Policy

Delivery (Yes) $4/mile One Way or $7/mile Round Trip from Pick Up to Drop Off location in Lihue to Delivery address on Kauai

Deliver (No)

Message *

Captcha (spam protection code) *

I herby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact. I am aware that I can revoke my consent at any time.

Note: Fields marked with * are required

Web View Mobile View

Logout Edit page