
FREE SHIPPING ON MOST ITEMS! FREE BATTERIES!!		1-800-449-8991 Help Us Save You Money...If you have free cell phone long distance call: 727-538-0604

DID YOU KNOW...
Electric wheelchairs may be COMPLETELY covered by Medicare

and/or private insurance, if you qualify??
To see if you qualify, click HERE

Easy Financing!!

Apply Online and Receive Notification within 2 business days! CLICK HERE

NEW PRODUCT!!
The Light Weight At'm Electric Wheelchair

Finally!! A truly light weight electric wheelchair!! Breaks down into 3 pieces. Heaviest piece only
34 lbs.!!
Price - $1799.00
CLICK HERE
or call For Details
1-800-449-8991

Can't Decide?
See our
SEATING GUIDE

Enter to win a FREE Electric Wheelchair!

Click HERE

Finance Center

Welcome to our finance center! If you are low on cash, we are here to help! Here at American Wheelchairs we want to be sure that you have every opportunity to receive the electric wheelchair, scooter, scooter or wheelchair lift, or lift chair that you need to enhance your mobility needs. Filling out our online application is as easy as 1, 2, 3 !!!

Apply Online and Receive Notification within 3 business days!

Chose the finance terms that fit your budget from 12 months to 60 months. Either way, there is no penalty for early repayment. This is not a lease!! This is a credit application to PURCHASE the mobility equipment you need.
Interest as low as 22.9%, depending on credit rating.
Fill out our online credit application form. We will let you know within 2 business days or less if you are approved.
When you are approved, we will send you the original loan paper to sign. Just sign and return to us and your new scooter, power wheelchair or lift chair will be on its way!

PLEASE ENTER YOUR NAME:

First Name: MI:
Last Name:
Mothers Maiden Name:

PLEASE GIVE US YOUR MAILING ADDRESS:

Address:
City:
State:
Zip/Postal Code:

RENT/MORTGAGE INFORMATION:
Length of time at this address:
Previous address (if less than 3 year):
Do you rent or own?     RENT    OWN
Monthly rent/mortgage:

CONTACT INFORMATION:
Home phone number:
Fax number:
E-mail address:

NAME AND PHONE NUMBER OF FRIEND OR RELATIVE NOT LIVING WITH YOU:

Name of friend :

Phone Number of friend:

PERSONAL INFORMATION:

Social security number:

Date of birth:

Driver License Number:

Driver License State:

EMPLOYMENT INFORMATION: (Note: An Income amount MUST be listed in order to process your application. If the applicant is retired or disabled, please list total annual income from SSI., pension funds, investments, etc..in the "other income per year" section. Also, please list the length of time you have been retired or disabled in months and/or years )

Are you retired? Yes No

Are you 100 % Disabled ? Yes No

Length of time disabled and/or retired :
Years: Months:

Name of employer/business:
Employer street address:
City:
State:
Zip/Postal code:
Employer phone number:
Length of time with employer/business (mo/yr):
Your salary:
Your position:
Household income per year:
Other income per year:

** Alimony, child support or separate income need not be revealed if you do not desire such information to be considered by the Bank in making decision.**

Previous employer address (if less than 2 years):

CO-APPLICANT INFORMATION:
(If single applicant, skip to bottom and click "submit" button.)

Relationship to applicant above:

CO-APPLICANT NAME:

First Name: MI:
Last Name:
Mothers Maiden Name:

CO-APPLICANT MAILING ADDRESS:

Address:
City:
State:
Zip/Postal Code:
Length of time at this address:
Previous address (if less than 1 year):

CO-APPLICANT RENT/MORTGAGE INFO:

Do you rent or own?   RENT    OWN
Monthly rent/mortgage:
Home phone number:
Fax number:
E-mail address:

Social security number:

Date of birth:

CO-APPLICANT EMPLOYMENT INFO:

Name of employer/business:
Employer street address:
City:
State:
Zip/Postal code:
Employer phone number:
Length of time with employer/business (mo/yr):
Your salary:
Your position:
Household income per year:

Other income per year:

What product are you interested in?
Requested Loan Amount?

** Alimony, child support or separate income need not be revealed if you do not desire such information to be considered by the Bank in making decision.**

Previous employer address (if less than 2 years):

COMMENTS: