Email Quote Form

Contact Our Sales Staff

Specialty Conversions

Other Custom Applications

Customers Used Inventory

New Lowered-Floor Minivans

Email Quote Form

Email General Form

Events of Interest

Para Transit Vans

Clock's Vehicle Inventory


	Name:
	Address:

	Phone:
	E-Mail:
	Type of Disability:
	How long in Chair:

Type of Wheel Chair:	Manual	Electric
Driving Experience:	Before	After	None
Can You Transfer?	Yes	No
Strongest Side:	Left	Right

	Make/Model of Chair:
	Make/Model of Vehicle:
	Ground level to top of hair:
	Tips of toes to end of rear wheel:
	Outside of front wheels:
	Outside of rear wheels:
	Eye level to floor:

Comments:

Grand Rapids
Clock Conversions
6700 Clay Ave. - Grand Rapids, MI 49548
Phone (616) 698-9400 - Fax (616) 698-9495
Or call us toll free at (800) 732-5625

Lansing
Clock Conversions
5540 S Pennsylvania Ave.
Suite 7
Lansing, MI 48911-4012
Phone (517) 272-4488 - Fax (517) 272-4468
Or call us toll free at (800) 377-0206

Traverse City
Clock Conversions
965 E Commerce Dr. - Traverse City, Michigan 49684
Phone (231) 943-9890 - Fax (231) 943-9893
Or call us toll free at (800) 935-7975