Wheelchair Hire Booking Form

Wheelchair Hire Booking Form

Bookings for courier delivery must be made by submitting the booking form below.

If you need the wheelchair in a hurry (under 24 hours) please call us after filling in the form and we can take your credit card details by phone.

Please select a valid form

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All wheelchair bookings are prepaid only by MasterCard,Visa or American Express at the time of booking.


  1. The period of hire of the equipment will commence on the date on which the goods are dispatched and or picked up from Roland Priestley Pty Ltd. In effect the time it leaves our premises and is returned to our premises. Courier delivery and pick up days are counted as rental days.
  2. The wheelchair is uninsured, The hirer accepts full responsibility for any damage to the wheelchair or any injury or damage to the wheelchair occupant or other persons or property as a result of operating the wheelchair. I authorise Roland Priestley Pty Ltd or Square Payments (which ever is applicable) to hold my credit card details and charge the supplied credit card for any repairs to the wheelchair up to the value of the wheelchair without consulting the card holder for any damage or loss (a receipt will be issued).
  3. The Wheelchair is uninsured, if the wheelchair is lost or stolen the hirer excepts full responsibility for the wheelchair and authorises Roland Priestley Pty Ltd or Square Payments to charge the supplied credit card up to and including the replacement value of the wheelchair for any loss or damage without consulting the card holder (a receipt will be issued).
  4. Roland Priestley Pty Ltd agrees to provide the wheelchair free of defects and in operational order. If the wheelchair were to fail during the hire period we will refund the unused portion of the hire or replace with an equivalent model at the hirer’s discretion. You the hirer agree Roland Priestley Pty Ltd is not responsible for any compensation beyond the wheelchair hire cost.
  5. The hirer agrees NOT to repair or modify the wheelchair in any way without the written approval of Roland Priestley Pty Ltd.
  6. An extension of hire may be extended by both parties agreeing. If an extension of rental is granted there is no need to fill out another agreement, you agree to your card will be charged for the extension of rental as per our advertised rates. This agreement will remain in force until the wheelchair is returned.
  7. Cancellation of hire: Hire is prepaid at the time of booking. Cancellations are accepted before the hire period has commenced. The hirer agrees to a $22.00 admin charge for cancelling the hire of a wheelchair, the balance will be refunded to the credit card number supplied. Once the wheelchair has been dispatched I the hirer agree to no refund for change of mind or change of circumstances.
  8. I agree to pay the rental rates advertised on the Roland Priestley website.
  9. I understand if I get a puncture I will meet the cost of repair. Only applicable to wheelchairs with pneumatic tyres.
  10. If the wheelchair is not returned on time I agree to pay any overdue charges by the supplied card.
  11. If using the courier service and the wheelchair is not available for pick up at the time booked. If the courier has to return for a second trip I the hirer agree to pay for this extra courier service chargeable to the credit card supplied.
  12. I agree to not overload the wheelchair and follow safe operating procedures. The load capacities are advertised on the Roland Priestley webpage.
  13. The Hire period will terminate should any of the following occur and Roland Priestley will be entitled to the return of the equipment. A) The hirer makes default in the payment by the due date of any fees or other amounts outstanding, or otherwise defaults in the service or performance of any terms of this agreement. B) The hirer does, or causes to be done, any act matter or thing to which is likely to endanger the safety of persons, condition or safe keeping of the equipment. C) Any other event occurs which constitutes, or evidence, on the hirer’s part a repudiation or refusal to be bound by the agreement.
  14. The hirer warrants that he/she is authorised to make this agreement on behalf of all persons who possess, use or operate the equipment during the period until the equipment is returned.
  15. The hirer accepts full responsibility of the wheelchair at all times if left with a hotel concierge or reception up until the wheelchair is picked up by the courier.
  16. Roland Priestley Pty Ltd accepts responsibility of the condition of the wheelchair while in the hands of the courier. If the wheelchair is delivered damaged, the hirer MUST notify Roland Priestley Pty Ltd immediately so another wheelchair can be dispatched and the damaged one picked up. No claims for courier damage will be accepted after 24 hours after receipt of the wheelchair.