Credit Application

Credit Application

Order Forms

Order forms to be printed or filled out online by the rehab center, clinician, ATP, occupational therapist and/or other health professional.

Power wheelchairs
Alltrack M3 | 0 – 300 lbAlltrack M3 - HD | 301 – 450 lbAlltrack M3 - Ascent | 0 – 250 lbAlltrack R3 | 0 – 300 LBAlltrack R3 - HD | 301 – 400 LBAlltrack HD3 | UP TO 550 LBAlltrack P3 | 0 – 300 LB
Power wheelchairs AADL order forms
AADL | Alltrack R3 | 0 – 300 LBAADL | Alltrack R3 - HD | 301 – 400 LBAADL | Alltrack P3 | 0 - 300 LB
Aftermarket - Power Positioning Systems
PPS | 0 – 300 LBBARIATRIC HD PPS | ABOVE 300 LB
Seating
CG Air | Therapeutic air cushionCG AIR | Therapeutic air cushion | ADP
scooters
GS series scooters
Personal Protection Equipment (PPE)
Personal Protection Equipment (PPE)
Walking Aids
STELLA ROLLATOR