Reservation

Please provide us with required information and click “Send”.
Wilgo will contact you within 24 hours.

Your Name (required)

Your Email (required)

Pick up date & time
* Please put your requested pick up time if you request pick up other than selectable time slot.

Pick up place (Fill the address, name of venue, hotel, airpot, train station, etc.)

Please fill your flight information if your requested pick up place is an airport.
Airline name Flight#

Destination (Fill the address, name of venue, hotel, airpot, train station, etc.)

Number of passengers
Wheelchair Accompanying

Wheelchair
Your own standard typeYour own electric typeYour own othersRental standard type (Free of charge while your ride)

Optional equipments
No thanksReclining Wheelchair

Your Message

Please confirm if all of your entries are correct especially your e-mail, and check the box left, then click "Send". Please be advised that your reservation is not confirmed just by sending this form. Wilgo will contact you so that the final reservation process will be completed.