If you have a roadworthy handicap vehicle that is adapted for use by those with disabilities, please fill out the following form. Please make sure to scroll down to fill in all the necessary information
Type of Vehicle
Please choose one...
Adapted for scooter
Non-adapted vehicle for disabled person who can transfer
Any repairs needed:
Estimated Cost for Repairs:
Estimated Value of Vehicle:
Please upload pictures of the vehicle or send from your phone to
Name & Address
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