Name *

First

Last

Company *

Email *

Phone *

Shipping address: *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Choose an Option Below: *

• Solution Inquiry
• Request Service
• Order Parts

Is the above address the same as the billing address? *

• Yes
• No

Please enter the billing address:

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

You may also detail below the quantity, part number, and description of parts required.

Is the service address the same as the one provided above?

• Yes
• No

Please provide the service address for your inquiry:

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Purchase Order Number

Equipment Model

Equipment Serial Number(s) *

Are the status lights flashing?

• Yes
• No

If so, which status code is indicated?

Please select an industry category:

• Retail: Shopping Cart Collection, Electric Shopping Carts, Inventory Management
• Industrial: Heavy Duty Tuggers for Manufacturing & Materials Handling
• Healthcare: Patient Transport, Equipment & Supply Transport
• Logistics: Order Fulfillment, Click & Collect, Distribution Center & Warehouse Management
• Transportation: Wheelchair Transport, Passenger Transport, Luggage Transport
• Commercial Cleaning: Ergonomic Janitorial Cleaning Cart
• Custom Design: Develop a Specialized Solution for Your Business

To request more information about a specific Dane solution, please select from the following:

• QuicKART Series
• PowerPal Series
• M3i Series
• Shopping Scooters
• Smart:System
• WheelChair Mover
• QuicKLEEN

Please describe the nature of your request with as much detail as possible: *

Submit