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TC Mobility Order Form
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
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Customer First Name
*
Customer Last Name
*
Customer's Phone
*
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 - $18,500
Speedster - $17,500
Chassis Color
*
Red
Blue
Green
Silver
White
Black
Purple
Custom (candy, metallic) +$150
Safety Restraint Color
*
Red
Blue
Gray
Black
Purple
Safety Restraint Upgrades
4-Point Harness
5-Point Harness
6-Point Harness
Cam-Lock Latch
Shoulder Pads
Arm Restraints
Seat Options
*
Cloth - Red
Cloth - Blue
Cloth - Black
Cloth - Yellow
Leather - Black +$185
Suede - Black/Gray +$125
Custom Upholstery +$1,100
Accessories
Bronco Bar
Tablet Mount
Cup Holder
Purse Hook
LED Light Bar w/ signals
Under Light Kit
12v Power Source
Custom Accessories - Call for Quote
Wheel Options
*
Red
Blue
Green
Yellow
Silver
White
Black
Purple
Chrome Plating +$765
Hydro Graphics +$395
Custom Paint - Call for Quote
Wheel Upgrades
Six Spoke (Standard)
Three Spoke +$600
Custom Billet (Starting at $2,150)
Track Options
*
Red
Blue
Green
Yellow
Silver
White
Black
Purple
Chrome Plating +$765
Hydro Graphics +$395
Custom Paint - Call for Quote
Shield Plates +$600
Estimated Total
$0.00
You won't be charged until we confirm your order over the phone, including any customizations or accessories you may have requested.
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