Recreational Scooter Order Form

Thank you for visiting our recreational scooter order form. Please be sure to enter a shipping address if your mailing address is a P.O. Box and complete the form entirely before submitting. Our Scooters are shipped at no cost to you within the continental U.S. Most orders placed before 2:00 P.M. , EST will ship the same day. Please allow 7 to 10 business days for delivery after placing your order ( However, most orders will arrive within 6 business days.). Overnight, second day or third day shipping is available to most address's at an additional fee. We do have a 30 day return policy. If you are unhappy with the item you have purchased, for any reason, you may return it within 30 days for a refund of the purchase price, less a 20% restocking fee and all shipping fees. For details, please see our RETURN POLICY. If you have any questions before or after placing your order, please feel free to contact us as listed below:

Phone	727-549-0604
Fax	727-549-0614
E-mail	sales@americanwheelchairs.com

Please enter your name as it appears on your credit card.

First name: Middle: Last name:

Please give us your mailing/billing address: (same address your credit card statements are mailed to)

Address 1:

Address2:

City:

State: ZIP/Postal code:

Phone Number: NOTE: Contact Telephone Number is Required

If your shipping address is different from your mailing address, please list it below (NOTE Shipping Address cannot be a PO Box! We must have a physical Address!!):

First name: Middle: Last name:

Address 1:

Address2:

City:

State: ZIP/Postal code:

E-mail address:

Phone number: NOTE: Contact Telephone Number is Required

Optional Information

Fax number:

Cell Phone:

Please select the item(s) that you would like to order:

Two Wheel Electric scooters:

Freedom model 644 - $339.00 Color:

Freedom model 648 - $339.00 Color:

City Bug E2 electric scooter - $249.00 Color:

Freedom model 903 - $169.00 Color:

Freedom model 903 w/seat- $179.00 Color:

Whisper electric 2 wheel - $499.00 Color:

Three Wheel Electric Scooters:

Freedom model 961 - $549.00 Color:

Two Wheel Gas Scooters:

Freedom model 975 - $489.00 Color:

Four and Five Wheel Electric Scooters:

CityBug Helper - $749.00 Color:

Select the credit card you would like to use:

Master Card

Visa

Discover

American Express

Please enter your credit card number

Please enter the expiration date on the credit card.

Additional questions, comments:

By clicking the "Submit" button below, you agree that you have read and accept our return policy.

Thank You!