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Customer wheelchair information

If you plan on traveling with your own wheelchair, please complete this form, laminate it if possible, and attach it to your wheelchair. You may type in your responses on the blank lines, click on the check boxes and print out the completed form, or print out the blank form and complete it by hand.

Please place a photo of your wheelchair here (if possible) and mark where to hold your chair in order to lift it.

Chair type:
Battery type:
Chair weight
Is it key operated?
Are there any removable parts (e.g., foot rests, seat cushions, etc.)?
Will you bring any parts of the chair into the aircraft cabin?
Are any tools required?

Note: Please provide airport personnel with any tools required to fold or dismantle your wheelchair