RECEIVE A 1% STORE CREDIT FOR ANY & ALL NEW CUSTOMER REFERRALS

CREATE AN ACCOUNT SO ALL THE AVAILABLE CREDITS ARE LINKED TO YOUR PROFILE
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STEP 2: FILL OUT THE FORM BELOW TO GET YOUR CARDS FOR FREE

REFERRAL Program

Our customers love their chairs so much that they can't help but telling other about the mobility, independence, and freedom they experience.

We now give back to those customers a 1% Store Credit for sharing their experience. Fill out the form below and we will ship you Referral Cards to pass out with your name on it.

• CUSTOMER NAME: (required)*
  First Last
• CUSTOMER EMAIL: (required)*
  Enter Email Confirm Email
• CUSTOMER PHONE NUMBER: (required)*
  Format (###) ###-###
• 
  
• How Many Referral Cards Would You Like? (required)*
  12345678910
• SHIP MY REFERRAL CARDS TO: (required)*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands
• 
  
• I UNDERSTAND, AGREE & COMPLY WITH THE FOLLOWING: (required)*
  Please check ALL THE BOXES to ensure you understand the guidelines for our Referral Program.
  • I CURRENTLY OWN A FOLD & GO WHEELCHAIR
  • MY 1% STORE CREDIT NEVER EXPIRES
  • REFERRALS CARDS ARE MAILED TO ME FREE OF CHARGE
  • MY CUSTOMER ACCOUNT IS IN GOOD STANDING
  • I MAY NOT USE MY STORE CREDIT TOWARDS INSURANCE PAYMENTS
  • I WILL NOT RECEIVE A REFUND FOR ITEMS RETURNED USING MY STORE CREDIT
  • I MAY NOT USE MY STORE CREDIT FOR NON-WARRANTY PARTS AND OR REPAIRS
  • STORE CREDIT ONLY APPLIES WHEN YOU SEND US A NEW CUSTOMER
• Did you Create an Account on Our Website? (required)*
  Your Account will list all the credits you have available. This makes it simple when you want to place your next order. You can select the coupon code and dollar amount to be applied to your order from your account.
  NOYESAlready Have One From When I First Ordered

STEP 3: HANDOUT THESE CARDS WITH YOUR NAME ON IT AND RECEIVE YOUR 1% STORE CREDIT