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Please fill out the form below and we will send you an itemized quote for your insurance provider.
Date
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Date Format: MM slash DD slash YYYY
Name of Policy Holder
*
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Last
Name of Intended User
*
First
Last
Address
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Street Address
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Alberta
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Quantity
Items to be Quoted
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TravelScoot Original Mobility Scooter
TravelScoot Aviator Mobility Scooter
TravelScoot Elite Mobility Scooter
Add Accessories
Foldable Shopping Basket
Footrest Support Plate
Suspension Seat Post
TravelScoot Throttle Assist
TravelScoot Travel Set
Foldable Shopping Basket
Price:
$ 45.00 CAD
Footrest Support Plate
Price:
$ 45.00 CAD
Suspension Seat Post
Price:
$ 65.00 CAD
TravelScoot Throttle Assist
Price:
$ 25.00 CAD
Beverage Holder & Mug Set
Price:
$ 75.00 CAD
TravelScoot Travel Set
Price:
$ 55.00 CAD
GST
Price:
$ 0.00 CAD
PST
Price:
$ 0.00 CAD
Total
$ 0.00 CAD
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