Order & Reservation Form

Aloha!

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

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 in providing assistance 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 & 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

Kauai Wheelchair will request payments by sending invoices for:

Credit Card Billing 

Venmo Billing

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