Midland Wheelchair Hire

Birmingham Area Wheelchair Hire - Delivery and Collection Included

Call Midland Wheelchair Hire...Office Hours ... Carrycall

Including postcodes B46, B77, B78, B79

Covering Coleshill, Water Orton

and including Wolverhampton

Title

First Name

Last Name

Contact No.

Address

Town/City

Postcode

User

Wheel Type

Wheelchair Type

Delivery Date

Hire Period

Elevating Leg Rest

Message

Subtotal

Payable