Order & Reservation Form

HomeOrder & Reservation Form

Aloha!

For safety reasons and company policy,  Kauai Wheelchair and A1 Lift LLC members are not permitted to assist equipment users into or out of wheelchairs or scooters. They are also prohibited from assisting with swimming, dressing, toileting, or other tasks. Non-Ambulatory Passengers must have adult supervision during transportation.  Thank you for your understanding.

Mahalo’s

Kauai Wheelchair Staff

Order and Reserve Form

Please simply provide us with your information in advance so we can have
your equipment readily available for pick up or delivery.

Please Initial

Fields marked with * are required

Order and Reserve Form

Please simply provide us with your information in advance so we can have
your equipment readily available for pick up or delivery.

Please Initial

Fields marked with * are required