Name

Email Address

Phone

Postcode (where the stairlift is located)

What is the make of the stairlift? What is the make of the stairlift?AcornBison (Not Purchased)BrooksBruno (Not Purchased)Companion (Not Purchased)Handicare (Not Purchased)Liftable (Not Purchased)Meditek (Not Purchased)Minivator (Not Purchased)Otolift (Not Purchased)StannahPlatinumThyssen (Not Purchased)Unsure

Is the Stairlift straight or curved? Is the Stairlift straight or curved?StraightCurvedOutdoorUnsure

How old is the stairlift? How old is the stairlift?0-1 year1-2 years3-4 years4-5 years5+ years

Do you require professional removal? Do you require professional removal? Yes No

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