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ELECTRIC SCOOTER & WHEELCHAIR RENTAL FORM
EVENT INFORMATION
*Event Name:
Event Date:
CUSTOMER INFORMATION
*Name:
*E-Mail:
Important! Enter a valid e-mail address. All correspondence and receipts will be sent to this address.
*Phone Number:
*Address Line 1:
Address Line 2:
*City:
State:
*ZIP Code:
RENTAL INFORMATION
Orders placed 24 hours or more before scheduled pick-up are eligible for the advance rate.
WHEELCHAIRS: Rent a wheelchair for a daily rate or a flat-rate for the entire event.
The standard wheelchairs are 18 to 20 inches wide and rated up to 250 lbs. The deluxe wheelchairs are 22 inches wide and rated up to 450 lbs.
Quantity:
number of wheelchairs needed
Standard Wheelchair: (250 lbs max)
Deluxe Wheelchair: (450 lbs max)
*Total:
If renting at the daily rate, enter the number of days in the box above.
ELECTRIC SCOOTERS: Rent an electric scooter for a daily rate or a flat-rate for the entire event.
Scooters are rated up to 300 lbs (standard) and up to 400 lbs (deluxe).
Quantity:
number of scooters needed
Standard Scooter: (300 lbs max)
Deluxe Scooter: (400 lbs max)
*Total:
If renting at the daily rate, enter the number of days in the box above.

Pick-Up Date:
Pick-Up Time:
Return Date:
Return Time:

OVERNIGHT OPTIONS: You can store your rental overnight at the Business Center or you can keep it with you for the entire rental duration. If you choose to store your rental in the Business Center we will store it in a secure location and charge the batteries overnight. If you choose to keep your rental with your, you will be responsible for securing it and keeping the batteries charged.
Overnight Options:
Store in the Business Center each night
Keep with you for the duration of the rental
DELIVERY OPTIONS: You can pick-up your rental equipment at the Business Center or we can deliver the equipment to any booth, meeting room or entrance at the Salt Palace.
Delivery Options:
Pick-up Rental at the Business Center
Deliver the Rental to me
Delivery Location:
DELIVERY LOCATION MUST BE INSIDE THE SALT PALACE CONVENTION CENTER. We cannot deliver any rental equipment outside of our facility.
A $10 fee for delivery will be applied. If a daily delivery is required, a $10 fee will be applied for each delivery date.
Deliver To (Name):
Additional Instructions:
TOTAL
*I agree to the Salt Palace Terms & Conditions
Subtotal:
UT State Tax (7.75%):
GRAND TOTAL:
OFFICE USE ONLY

For additional information, contact Salt Palace Business Center:
100 S West Temple, Salt Lake City, UT 84101
(385) 468-2228 PHONE (385) 468-2172 FAX
businesscenter@saltpalace.com

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