Request a Quote

Please fill out the form below and we will send you an itemized quote for your insurance provider.

Date*
MM slash DD slash YYYY
Name of Policy Holder*
First Last
Name of Intended User*
First Last
Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Email*
Quantity
Items to be Quoted*
Add Accessories
- Foldable Shopping Basket
- TravelScoot Throttle Assist
- TravelScoot Travel Set
- Footrest Support Plate
- TravelScoot Deluxe Seat
- Rear Luggage Kit
- Footrest Extension Kit
Foldable Shopping Basket
Price:
Suspension Seat Post
Price:
TravelScoot Throttle Assist
Price:
Beverage Holder & Mug Set
Price:
TravelScoot Travel Set
Price:
Footrest Support Plate
Price:
Rear Luggage Kit
Price:
Footrest Extension Kit
Price:
TravelScoot Deluxe Seat
Price:
GST
Price: $ 0.00 CAD
PST
Price: $ 0.00 CAD
Total
$ 0.00 CAD
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