Request Service or Repairs

First name*

Last name*

Email*

Phone*

ZIP code*

Equipment in need of service*
please select oneScooterPower wheelchairLift chairVehicle liftManual wheelchairOther

Issues with equipment

Can you bring the equipment into our store location in Bridgeport, or would you need us to come to your home for repairs?*
please select oneI can bring it to the storeI need service at my home

New or current customer
please select oneNew CustomerCurrent Customer

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