Roam hitching bike

Pass form

Please complete this pass form completely and merge it with the configuration of the Roam product, which can be downloaded in PDF format.This form is intended for Roam dealers only. If a fitting together with a Roam advisor has taken place, filling it in is not necessary.

Roadmap:

Fill in the fitting form as completely as possible.

After completing it, click on send. The form is automatically sent to our info mailbox and a copy is sent to the completed mail address.

Using the configurator on each product page, put together a Roam in detail.

When the configuration is complete, click on "name and address details". After filling in, click send.The form is automatically sent to the completed mail address. Please forward it to info@roam.nl

Only need a configuration overview? Then click on print and select the desired download.

Once both forms have been received by us, we can put together an offer.

Download Pass form

Date:
Dealer + branch (location):
Consultant/seller name:
E-mail address:
Consultant/salesperson phone number:
Customer:
Phone number of client
Brand wheelchair:
Wheelchair type/model:
Type of wheelchair frame:
Leg support type:
Select bike:
select adapter (central tube):
Depot remedy redistribution applicable:
Photo of stakeholder in wheelchair (without appearing recognisably in picture):
A size:
B size:
C Size:
M size:
V size:
Measurement method
Ref number dealer:
Quote/order number Roam (if known):
Notes:

Send

* mandatory input field