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Special Needs at Sea - Partners

Please use the form below to send partner information. All fields with a * are mandatory.

Company:

Contact Name:*

Contact Email:*
Address:
City:
State:
Country:
Postal Code:
Phone:*
Fax:
Web Address:
Nature of Business:
Cities/Ports interested in Serving:

Do you have accessible vehicles capable of meeting customers at airports or ports?
If so, what kind?

Yes No

 

   
Type of Equipment You have Available for Rent: First Cylinder Packer (Regulator, Cart/Carry Bag, Cylinder)
Oxygen Conserving Devices
Oxygen Cylinder - M6
Oxygen Cylinder - C
Oxygen Cylinder - D
Oxygen Cylinder - E
Liquid Oxygen - Helios (H46) Stationary Units
Liquid Oxygen - Puritan Bennett (C41) Stationary Units
Liquid Oxygen - Helios (H300) Portable Unit
Liquid Oxygen - Puritan Bennett (C1000) Portable Unit
Oxygen Concentrators
Airsep Oxygen Concentrators
Transport Wheelchairs- 250 lbs
Standard Wheelchairs - 250 lbs
22" Extra-wide Wheelchairs - 350 lbs
Bariatric Wheelchair - 700 lbs (anything above 350)
Elevating Leg Rest - Standard
Elevating Leg Rest - Heavy Duty
Elevating Leg Rest - Bariatric
Standard Mobility Scooters - 250 lbs
Heavy Duty Mobility Scooters - 350 lbs
Bariatric Mobility Scooters - 500 lbs
Powerchairs
Standard Recliners
Lift Chairs
Patient Lifts
Trapeze
Full Electric Hospital Bed
Semi-Electric Hospital Bed
Shower Chair
Transfer Bench
Commodes
Rollators
Walkers