Wheels On Holiday, Handicap travel

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Dialysis in Spain

Hotels in Spain

Excursion in Spain

Rental Equipment in Spain

Where in South Africa

Information Form

Reservation Form

Customer review

information form

In order to serve you in the best way,
we need to get to know you first.
To book your holiday with us, you should first complete this
information form and e-mail it to us.
Within two days you will receive all the information.

We do not make any flight reservation or
booking by any airline from your country.

Name:
Address:
City:
Zipcode:
Country:
Phone day (no Mobil):
Phone evening (no Mobil):
E-mail:
Choice of hotel or apartment in Spain:
Supplements? Breakfast Half board Full board
The length of your stay:
The date of your Holiday:
1st choice : from Till
2nd choice : from Till

Do you need rental equipment in Spain:

Choice your travel package in South Africa:

12 days holiday self drive and car rental "BIG 5"
12 days organised Group holiday "BIG 5"
7 days organised group holiday "BIG 5"
15 days organised group holiday "SAFARI"
Which month would you to South Africa go?

Name of persons travelling with you:

1. Name Age
2. Name Age
3. Name Age
4. Name Age
Transfer in: Self Propelled wheelchair or Motorized wheelchair
Will you require a shower/WC chair?     Yes     No
Your height:
Your age:
Can you walk? No Yes, If Yes, how far
My upper body strength is: poor not bad good
The sum of 10 and 4 is: