Griffin Lifts Stairlift Rental Form

Saturday 4, September 2010
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Griffin Lifts Stairlift Rental Form

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Griffin Medical Associates rents stairlifts throughout North Alabama and Southern Tennessee.
Please fill out the following form to receive information on renting a stairlift from Griffin Lifts. Once recieved, someone from our customer service department will contact you to provide you with more information and answer anyquestions you may have.

Thank you for allowing Griffin Lifts a chance to earn your business.

Sincerely
Customer Service
Griffin Medical Associates, Inc.

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Phone Number:

Email address:

Length of rental time: Help/More Info

How did you here about our company?:
Medical company or organization
Brochure or ad
Search engine / Internet
Other

If other, Please list below:

What type of stairs do you have?:
Stained wooden
Framed and carpeted
Wood with carpet runner
Concrete
Other

If other, Please specify:

Comments:

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