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.
* Required
Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Wheelchair Type
*
Habibi Mini (Assisted)
Habibi Lightweight (Self-Wheel)
Habibi Prime (Self-Wheel)
Start of rental
*
MM
/
DD
/
YYYY
End of rental
*
MM
/
DD
/
YYYY
Address
*
Your answer
Type of Usage (Refundable Deposit)
*
Choose
Local Use ($100)
Overseas Use ($150)
Other thoughts or comments
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