MOBILITY SCOOTER CARRIER

Customer Information

Name:
Address:
City:State:Zip Code:
Phone with Area Code: Fax:

Method of Payment:CheckVisa, Mastercard or Discover
Credit Card Number:
Expiration Date:

Versa-Haul Mobility Scooter Carrier

Part Number	Description	Qty	Price
51009-1	VH-MS, Mobility Scooter Carrier - Hitchmount. Ramp included.		$749.
51009-2	VH-MS XL, Mobility Scooter Carrier - Hitchmount. Ramp included		$899.

Accessories

Part Number	Description	Qty	Price
	VH-HR3, Hitch Riser Class III		$129.
	VH-HR2, Hitch Riser Class II		$127.

Total Cost

Lift Cost
CA Residents Add Local Sales Tax
Shipping & Handling	FREE
Total Cost

There are 2 ways to submit your order,

• Print a copy and mail to the address below, or
• Call us at Call us at 530.913.2020 or email info@sportslift.com