Nor-Cal Mobility Contact Us form

Jun

Friday, June 25, 2010 @ 9:26:00 AM - Written by America's Heroes at Work | 0 comments

This free online tool provides access to thousands of services, programs and resources at the national, state and community level.

Apr

Friday, April 30, 2010 @ 3:37:00 PM | 0 comments

In an article in the New York Times, writer Tanya Mohn explains how travel is becoming more accessible.

INFORMATION REQUEST FORM


Name :
Address :

City :
State :		Zip Code :
Country :
Phone :
E-mail :

Is this your first accessible vehicle? Yes No
Disabled person's age:
Disabled person's disability:
Height in wheelchair:
What type of wheelchair: Manual Wheelchair Electric Wheelchair
Are you intending to drive? Yes No
Do you have the ability to transfer? Yes No
Would you like an in home demonstration? Yes No

Specific Comments / Questions :

Yes, I would like to receive your monthly newsletter and bulletins by mail.