Ridgid Wheelchair Information Form | Abiliquip

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Rigid Chair Information Sheet

Bottom Left
Name*
First Last
Phone*
Email*
Chair Manufacturer
Chair Model
Vehicle Model
Vehicle Year
Dimensions
D1
D2
D3
D4
D5
D6
Would you like to make a vehicle suggestion
Section Break
If you need to change your vehicle and want us to recommend one that suits the loader, please guide us in your other requirements or preferences: Seat squab height best for transfer:
Car $ Range
Car Age Range
Car Type
- Wagon
- SUV
- People Carrier
Rear seat to be used
- Yes
- No
Car Brands I like
Name
This field is for validation purposes and should be left unchanged.

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Hornby
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