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Rental Customer’s Information Form

Thank you for your interest in renting a wheelchair-accessible van from Superior Van & Mobility. In order to begin your wheelchair van rental reservation request, please fill-out and submit the form on this page.  NOTE: The information you submit should be for the person who will be driving/renting the vehicle. 

Once we receive your information, one of our our rental managers will review your request. You will receive a call or email confirmation once complete, and your reservation is confirmed. 

In the meantime, if you have any additional questions, please do not hesitate to reach out to one of our team members at the number below.

General Rental Information

Reservation Details:

  • Rental reservation must be in the driver’s name.
  • Must be 23 years of age or older to drive or rent.
  • If a Commercial Businesses, we will require a certificate of liability.
  • Our rental vans have removable front seating to allow wheelchair users the comforts of riding upfront.
  • If a loved one uses a manual bariatric wheelchair, you must rent a rear-entry or ADA Ford Transit for transport due to its size.
  • Holiday rentals are a minimum of 3 to 5 days, depending on the holiday.
  • Pick-up and drop-off hours are Monday through Friday, 8:00 AM to 5:00 PM.
  • Our offices are closed on weekends; therefore, the minimum weekend rental is two days. Pick-up time for weekend rentals is 4 PM on Friday, with the return of the vehicle no later than 8 AM on Monday. NOTE: For convenience, rentals can be dropped off anytime over the weekend using our after-hour key drop.

Rate Details:

  • 125 miles per day for minivan rentals (150 miles per day on ADA Ford Transit rentals) – $.35 per mile overage.
  • Cancellation Fee – $100 fee is not canceled 48 hours before scheduled pick-up time.
  • Your credit or debit card will not be charged until the day of pick-up.
  • We have in-town delivery & pick-up available for $100 or $50 if you only require one-way service. If you are outside our in-town delivery area, call for pricing. The maximum distance for delivery or pick-up is 1.5 hours from our rental location.
  • If you are parking or leaving your rental for pick-up at an airport, you are responsible for airport parking fees, etc.
  • Drivers are responsible for any municipal tickets issued (speeding, parking, etc.), toll booth charges, towing charges, etc. Plus, any damages resulting from such.
  • Fuel Charge – All rentals come with a full tank of gas. There is a $95 refueling charge if you return the vehicle with less than a full tank.
  • Clean-up Fee – There is a clean-up fee if the van is returned in poor condition (excessive dirt or pet hair, spilled food, or drinks, smoking inside the vehicle). This fee can be over $200.00 + tax, based on the severity.

Rental Details and Pick Up:

  • Our van rentals are for 24 hours increments. Example: If you pick up at 9:30 AM on a Monday for a one-day rental, it is due back by 9:30 AM on Tuesday.
  • When you rent for the first time, even though you’ve submitted your license & insurance information, you must bring them with you when picking up your rental. Having copies on file is a MANDATORY requirement of our insurance carrier.
  • Our rentals do not have handicap license plates. If you plan on using handicap parking, you must use your hanging placard.
  • All vans are non-smoking.

Drivers and Passenger Details:

  • If adding an additional driver, they must also submit their information and sign the contract when picking up the rental.
  • All drivers must have current full coverage insurance that includes comprehensive and collision coverage. Coverage must be transferable to cover wheelchair-accessible van rentals. We do not provide insurance coverage options. NOTE: Insurance coverage on a credit card is not accepted.
  • Hand controls and other driving aids are available for those with a driver’s license amendment. Please let us know if you require hand controls when booking your rental. Your rental needs to be scheduled at least three days before the pick-up date to ensure time for installation.

Learn More about Our Wheelchair Van Rentals

RENTAL CUSTOMER INFORMATION
Rental Location*
First Name*
Last Name*
Pick-Up Date*
Pick-Up Time*
Return Date*
Return Time*
Phone*
Email*
ADDRESS INFORMATION
Address Line 1*
Address Line 2
City*
State*
ZIP Code*
Your Organization's Name
DRIVER'S LICENSE INFORMATION
Driver's License Number*
State*
Date of Birth*
Expiration Date*
INSURANCE INFORMATION
Insurance Company*
Agents Name*
Agents Phone*
Policy Number*
Exp. Date*
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