Request a Rental

Beginning Date*

End Date*

Delivery or pick up at store location in Bridgeport?*
please select oneDeliveryPickup at store

If delivery, enter delivery address.

Height of user*

Weight of user*

First name*

Last name*

Email*

Phone number*

Notes

By submitting this rental request online, this does not guarantee your rental has been reserved. Someone from Amigo Mobility Center will contact you for further details and payment.

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