Hanicap Vehicles Rentals


rear entry mini-van side entry full size van side entry mini-van side entry transport van
       
Class Standard Premium Full Size
Vehicle Type Accessible Mini Van Accessible Mini Van Handicap Transport Van
Description Medium, Mileage (03-09) Late models low mileage Late models
Daily (2 -3 Days) $100.00 $100.00 $100.00
Daily (4-6 Days) $84.00 $84.00 $90.00
Weekly $588.00 $588.00 $630.00
Monthly $1850.00 $1850.00 $1950.00


To request a handicap van rental quote please submit the following form.

We will contact you shortly with your customized quote. For A Quote By Phone : 1 (866) 322-4400

Contact Information

Mr. Mrs. Ms.

Renters Name (Required)
Address
City State Zip
Phone #
Preferred time of day to call:
Email  (Required)

Pickup & Return Information
(Monday-Saturday, 8:30am-4:00pm, We also deliver on Sundays & Odd Hours)

Pickup Location
Dropoff Location
   
Pickup Date
Pickup Time
   
Dropoff Date
Dropoff Time

Airline Travel Information

Arrival Airline
Arrival Time
Flight #
   
Departure Airline
Departure Time
Flight #

Driver's Insurance Information

Driver's Insurance Company
Insurance Policy #
Expiration Date:
Insurance Agent's Name
Insurance Agent's Phone # Area code: Prefix: Number:
Does Policy Cover Rental Vehicles? Yes No

Driver Information   (As it appears on valid drivers license)

Primary Driver
Driver's License #
State Exp. DOB
Additional Driver
Driver's License #
State Exp. DOB

Local Address while staying in Florida

Hotel/Resident Name
Address
City State Zip
Local Phone # Area code: Prefix: Number:
Will the vehicle be driven outside of Florida?     Yes No  

Method of Payment

Visa Master Card

Disability Information

Please describe disability in order for use to assist with the correct transportation needs.

Accessibility Options
(Vehicles are not equipped to drive from a wheelchair. Driver must be able to use a transfer seat)

Total Number of passengers (including driver)    
Number of Passengers in Wheelchair/Scooter    
Passenger Seat Removed      Yes No
Hand Controls     Yes No
Wheelchair Scooter     
Manufacturer     Model         
Occupants height from ground to top of hair while sitting in wheelchair /scooter         
Other Special Needs         

Emergency Contact Information

Name
Relationship
Phone Area code: Prefix: Number:
   
   
Image Verification:

 Type the word exactly as it appears in the image to the right.
   

Orlando Truck Rentals reserves the right to cancel any reservation and/or advertised offers, correct any errors, inaccuracies or omissions inclusive of all reseverations submitted online and offline. Any errors will be corrected upon discovery.