Quotation request

Personality

Title

Initial

Name(required)

Age

Street

House-Nbr

ZIP code

City

Telephone(required)

Country

Your e-mail(required)

Destination

1st desire

2nd desire

Earliest arrival at

Latest departure on

Desired length of stay

Number of adults

Number of children

Adapted single bedroom

Adapted doublebedroom

Adapted 3 bedroom

Adapted apartment / bungalow

Single bedroom

Doublebedroom

3 Bedroom

Apartment / bungalow

Self catering

With breakfast

Half board

Vol board

All Inclusive

Age of the children at the time of travel

1st Child

2nd Child

3rd Child

4th Child

5th Child

6th Child

7th Child

8th Child

9th Child

Desired type of transport

Depending on destination

Numbers of wheelchairs

Numbers of electric wheelchairs

Numbers of electric scooter

Desires a taxi to the train station

Address

Train station

Transportation from train station to accommodation

From the front door to the Aeroport (round-trip)

Own transfer

Group transfer

Private transfer

Desired aeroport(s) of departure

From aeroport to the accommodation (round-trip)

Own transfer

Group transfer

Private transfer

Support during the holidays

Medical care

1st care moment

duration

2nd care moment

duration

3rd care moment

duration

Necessary equipment to rent

Electric adjustable high-low bed

Side rails

Bed gallows

Foam mattress

Anti-decubitus mattress (alternating pressure system)

Bed higher

A person lift

Shower chair

Shower wheelchair

Toilet seat raised

Oxygen

Mobility equipment to rent

Elektric scooters

Wheelchair

Push wheelchair

Electric wheelchair

Swiss Trac

Your Message

How and/or through whom did you hear or read about us?

This field should be left blank

Please wait...

For all your questions and comments, you can use our form.

Quotation request

Contact

HIER STAAN WIJ VOOR

Our Mission

WE STAND FOR