Rent to Own Agreement Form | ZipZac | Mobility Chairs

For those from Canada, Click Here to connect with our distributor, Active Healthcare Solutions LLC.

HOME
PRODUCTS
STORE
- ZipZac
- Accessories
TECHNICAL
ABOUT US
CONTACT

RENT TO OWN Agreement

First Name:

Last Name:

Phone:

Message:

Email:

Shipping Address

City

State

Zip Code

Choose One

ZipZac I- Red

ZipZac II- Blue

ZipZac II- Pink

Name on Credit Card

Number on Credit Card

Exp Month

Exp Year

Security Code

Billing Zip Code

Required

I agree with the terms and conditions of the Rent to Own program

Thank you for your order. We will confirm this with you shortly.

Oops, there was an error sending your message.
Please try again later.

Share by: