Reservation Form

Rental Vehicle Choice #1 (see above photos) *

DeBug Push/Unpowered Beach Wheelchair, $65/day, 275# weight limit

Nomad Powered Beach Wheelchair, $109/day, 275# weight limit, (not transportable)

Pride GoGo 4 Wheel Mobility Scooter, $65/day, under 275# operator, (transportable)

Pride Pursuit Mobility Scooter, $79/day, up to 400# operator, (not transportable)

ROVR Mobility Scooter for off-pavement use, $79/day, up to 350# operator (not transportable)

Rental Vehicle Choice #2 *

(SELECT "NONE" UNLESS YOU'RE RESERVING MORE THAN ONE VEHICLE!)

None

DeBug Push/Unpowered Beach Wheelchair, $65/day, 275# weight limit

Nomad Powered Beach Wheelchair, $109/day, 275# weight limit, (not transportable)

Pride GoGo 4 Wheel Mobility Scooter, $65/day, under 275# operator, (transportable)

Pride Pursuit Mobility Scooter, $79/day, up to 400# operator, (not transportable)

ROVR Mobility Scooter for off-pavement use, $79/day, up to 350# operator (not transportable)

Rental Vehicle Choice #3 *

(SELECT "NONE" UNLESS YOU'RE RESERVING MORE THAN ONE VEHICLE!)

None

DeBug Push/Unpowered Beach Wheelchair, $65/day, 275# weight limit

Nomad Powered Beach Wheelchair, $109/day, 275# weight limit, (not transportable)

Pride GoGo 4 Wheel Mobility Scooter, $65/day, under 275# operator, (transportable)

Pride Pursuit Mobility Scooter, $79/day, up to 400# operator, (not transportable)

ROVR Mobility Scooter for off-pavement use, $79/day, up to 350# operator (not transportable)

Full name of person making reservation *

First Name

Last Name

Full name of contact during rental *

First Name

Last Name

Primary telephone number for person making reservation *

(###)

###

####

Secondary telephone number for person making reservation (in the event primary phone is damaged or lost during rental period) *

(###)

###

####

Full Name of Occupant *

First Name

Last Name

Date to be delivered *

MM

DD

YYYY

Delievery Time *

Hour_ Min_

Hour

Minute

Second

AM PM

Date to be picked up *

MM

DD

YYYY

Pickup Time *

Hour _ Min_

Hour

Minute

Second

AM PM

Home Physical Address Street (No PO BOXES)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I acknowledge the following about delivery *

I understand there is a minimum delivery (includes pickup) fee of $45 in addition to any rental rate plus tax.

Please acknowledge weight maximum *

I understand the following operator weight limits apply as follows: the DeBug, Nomad, and GoGo Mobility Scooters have a maximum operator weight limit of 275lbs. The ROVR and Pride Pursuit have a maximum operator weight of 400lbs when used on land. Only the ROVR scooter can go off-road, and that has a 300lb off-road limitation.

Please acknowledge occupancy *

I understand that all Beach Mobility Rentals equipment is designed for solo operator use only, and does not allow for carrying pets, children, or cargo beyond small personal items in baskets (if provided).

Please acknowledge proper operation below *

I understand that use of any of the BMR rental vehicles presents an inherent danger to myself or others for the improper use of said equipment. If at any time I realize a threat to my safety or the safety of others, I will immediately stop use and notify BMR or it's agents.

Please acknowledge battery information below *

I understand that any powered vehicle that has a power meter indicates to me the state of charge. Green indicates full or near full, yellow indicates medium level, and red means empty. If only the red light appears, then I cannot use the vehicle. A red only light indicates the battery is in an unsafe zone, and it is my responsibility to replace the batteries at my cost should I continue to operate the vehicle in the "red zone" and damage to the batteries occur. All batteries in the red zone must be immediately turned off and charged to full capacity (usually 4-6hrs).

FULL/ SAFE

LOW/CAUTION

STOP/CHARGE

Please acknowledge battery longevity below *

Please acknowledge battery longevity below

Please acknowledge refund policy below *

I understand that a delivered rental is non-refundable unless otherwise excepted by Beach Mobility.

Please acknowledge abuse policy below *

If you accept a rental, and whether used or not, upon return or after return, demand a refund, threaten a charge reversal, or make any other threats, without having first and immediately spoken with Nanette about any issues during the rental, you will be considered in violation of FL Statute 812.014, Theft of Services, and charges will be brought against you. We take these matters seriously as we pride our business for offering a great value, a great product, and we go to great lengths to serve our clients. Anyone who abuses this is regarded as someone who enjoys a full meal, then complains when the check comes, demanding to eat free. We do not play these games, and will use everything within legal power to combat abuse. I'm sorry this has to be said, but in recent years, just a couple of rogue customers have acted in this manner, and we must make a policy stand. Thank you for understanding.

Please acknowledge below *

I understand that at the end of my rental use, any powered vehicle will be fully charged, cleaned, and made rental-ready prior to pickup, and any non-powered rental will also be returned in cleaned and rental-ready condition.

Please acknowledge below *

I understand that I am to notify BMR or any of it's agents immediately upon damaging a vehicle, and that in the event of an emergency, I am not to abandon the vehicle. I further acknowledge that any damage to other property is my responsibility, and that I will notify BMR or any of its agents immediately, as well as the property owner(s).

Please acknowledge below *

I understand that I am fully responsible for the safekeeping of any rental vehicle, and to make any prior arrangements with the hotel, condo, rental homeowner for adequate storage. Please contact BMR for assistance with this if necessary. This is a mobility device, so make sure they are aware of such, as ADA compliance is necessary on their part. While private condominiums and homes don’t have to abide by all ADA compliance concerns, they are responsible for providing safe passage and access through public use areas. In the past, private condominiums have disallowed renters from charging their power beach equipment on facility grounds. One manager stated “these are recreational and we don’t have to accommodate these.” While these are recreational, there is no “legal” definition of the class of assistive vehicles whereby one cannot be deemed recreational v necessity.

Please acknowledge below *

I acknowledge that the answers to the above are true and correct, nothing has been forged, and I accept that I will transfer all knowledge of proper operation to the person operating the chair, and accept their use as my use. I further understand that this form will be sent to Beach Mobility Rentals LLC for the purpose of securing my reservation, and kept on file for rental use.

Please acknowledge below *

If I do not understand any of the above, I acknowledge here in this answer that I have clarified anything with BMR and hereby accept all as understood. Contact numbers for questions are 386-882-7263 (Nanette) or 911 (for emergencies)

Please acknowledge below *

Please contact Nanette at 386-882-7263 to pay for the rental. Please note all CC payments incur a 4% surcharge on the total.