Accessories Order Form

Thank you for visiting our accessory order form.  Please be sure to enter a shipping address if your mailing address is a P.O. Box and complete the form entirely before submitting.   Our Accessories are shipped at no cost to you within the continental U.S. Most orders placed before 2:00 P.M. , EST will ship the same day. Please allow 7 to 10 business days for delivery after placing your order ( However, most orders will arrive within 6 business days.). Overnight, second day or third day shipping is available to most address's at an additional fee. We do have a 30 day return policy. If you are unhappy with the item you have purchased, for any reason, you may return it within 30 days for a refund of the purchase price, less a 20% restocking fee and all shipping fees. For details, please see our RETURN POLICY. If you have any questions before or after placing your order, please feel free to contact us as listed below:

Toll Free

1-800-449-8991

Phone

727-549-0604

Fax

727-549-0614

E-mail

sales@americanwheelchairs.com

 

Please enter the billing name as it appears on your credit card.

First name:    Middle: Last name:   

Please give us your mailing/billing address: (same address your credit card statements are mailed to)

Address 1:   

Address2:   

City:   

State:      ZIP/Postal code:

Phone Number:   NOTE: Contact Telephone Number is Required

If the shipping name and address is different from your mailing name and address, please list it below (NOTE Shipping Address cannot be a PO Box! We must have a physical Address!!):

First name:    Middle: Last name:   

Address 1:   

Address2:   

City:   

State:      ZIP/Postal code:

E-mail address:   

Phone number:      NOTE: Contact Telephone Number is Required

Optional Information

Fax number:   

Cell Phone:     

Please select the accessories that you would like to order:

 Baskets and Accessory Holders for Wheelchairs and Scooters

Walker Holder- $89.95  

Snap-In Cane Holder- $19.95

Cane / Crutch Holder $89.95

Quad Cane Holder - $89.95 

Oxygen Holder - $89.95

Rear Basket - $79.95

Front Basket - $89.95

 

Storage Bags

Standard Arm Rest Bag - $29.95 

Front Mount Arm Rest Bag - $59.95

Extra Large Arm Rest Bag  - $59.95

Standard Seat Back Bag  - $59.95  

Deluxe Seat Back Bag - $79.95

Deluxe Seat Back Bag with Side Access - $89.95

Seat Back Monster Bag  - $89.95

Wheelchair and Scooter Covers

Heavy Duty Scooter Cover  - $92.95

Heavy Duty Extra Large Scooter Cover  - $99.95

Heavy Duty Electric Wheelchair Cover  - $82.95

Manual Wheelchair Cover - $79.95

Batteries for Electric Wheelchairs and Scooters

12 Volt, 8ah (set of two) - $139.95  Make of Vehicle:   Model of Vehicle: 

12 Volt, 12ah (set of two) - $159.95  Make of Vehicle:   Model of Vehicle: 

12 Volt, 18ah (set of two) - $189.95   Make of Vehicle:   Model of Vehicle: 

  12 Volt, 33ah (set of two) - $289.95   Make of Vehicle:   Model of Vehicle: 

  12 Volt, 55ah (set of two) - $329.95   Make of Vehicle:   Model of Vehicle: 

  12 Volt, 75ah (set of two) - $469.95   Make of Vehicle:   Model of Vehicle: 

  12 Volt, 110-ah (set of two) - $579.95  Make of Vehicle:   Model of Vehicle: 

 

Miscellaneous Wheelchairs and Scooter Accessories

Weather Breaker Canopy  - 

                 Canopy Model Choice:  

                 Canopy  Color Choice : 

                 Canopy Size Choice:     

                 Canopy Use Choice:        Make of Vehicle:   Model of Vehicle:    

Cup Holder - $19.95  Make of Vehicle:   Model of Vehicle: 

Safety Flag - $25.95  Make of Vehicle:   Model of Vehicle: 

Rear View Mirror - $19.95   Make of Vehicle:   Model of Vehicle: 

 "H" Belt for Positioning - $119.95   Make of Vehicle:   Model of Vehicle: 

 "Butterfly" Positioning Belt - $139.95   Make of Vehicle:   Model of Vehicle: 

  Standard Lap Belt - $39.95   Make of Vehicle:   Model of Vehicle: 

  Anti Theft/Folding Bar - $39.95  Make of Vehicle:   Model of Vehicle: 

 

 

Select the credit card you would like to use:

       Master Card

       Visa

       Discover

       American Express

Please enter your credit card number

Please enter the expiration date on the credit card.

Please enter the 3 or 4 digit security code on the credit card:

Additional questions, comments:

By clicking the "Submit" button below, you agree that you have read and accept our return policy.

Thank You!