TC Mobility Order Form Use this form to place an order or register your interest in a Tank Chair or Speedster. You won't be charged until we confirm your order with you by phone. Step 1 of 3 33% Customer First Name:*Customer Last Name:*Customer's Phone Number:*Customer's Email:*Shipping Address:*City:*State:*Zip Code:*Billing/Mailing Information (if different from Service Address)Billing/Mailing Address:City:State:Zip Code: Mobility Device Type:*Tank Chair - $18,500Speedster - $17,500Chassis Color:*RedBlueGreenSilverWhiteBlackPurpleCustom (candy, metallic)Safety Restraint Color:*RedBlueGrayBlackPurpleSafety Restraint Upgrades:4-Point Harness5-Point Harness6-Point HarnessCam-Lock LatchShoulder PadsArm RestraintsSeat Options:*Cloth - RedCloth - BlueCloth - BlackCloth - YellowLeather - BlackSuede - Black/GrayCustom UpholsteryAccessories:Bronco BarTablet MountCup HolderPurse HookLED Light Bar w/ signalsUnder Light Kit12v Power SourceCustom Accessories - Call for QuoteWheel Options:*RedBlueGreenYellowSilverWhiteBlackPurpleChrome PlatingHydro GraphicsCustom Paint - Call for QuoteWheel Upgrades (Speedster Only):Six Spoke (Standard)Three SpokeCustom Billet (Starting at $2,150)Track Options:*RedBlueGreenYellowSilverWhiteBlackPurpleChrome PlatingHydro GraphicsCustom Paint - Call for QuoteShield Plates Estimated Total$0.00You won't be charged until we confirm your order over the phone, including any customizations or accessories you may have requested.Terms & Conditions*I agree to the terms & conditionsClick to open the terms & conditions in a new window ยป
