Habibi Wheelchair Booking Form
We will contact you shortly. Alternatively, you may contact us on our Hotline: (+65) 8828-1538. You can CALL, SMS OR WHATSAPP whichever floats your boat.
Name *
Your answer
Phone Number *
Your answer
Email *
Your answer
Wheelchair Type *
Start of rental *
MM
/
DD
/
YYYY
End of rental *
MM
/
DD
/
YYYY
Address *
Your answer
Type of Usage (Refundable Deposit) *
Other thoughts or comments
Your answer
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