Full Size Van or Pickup Truck Please enable JavaScript in your browser to complete this form.Full Name or Campany Name *Email Address *Phone Number *Zip Code *Year *Mileage *Vehicle Make *Trim Level *Lift Usable Width in inches *Lift Usable Length in inches *Entrance Height at point of wheelchair entry in inches *Interior Midship Height of Vehicle in inches *Select All Item Below that Apply to this VehicleRemote Lift Control (not corded)Lift Operation in the Front Dash AreaLift Operation near Rear Tail LightsTransfer SeatUsing the picture above determine if your van has the features listed and select those featuresThe vehicle has only one lift armThe van has an 8 inch flap along the side of the lift platform that comes down with the end safety flap (EZ Access Corner)The Platform Folds Down When it Comes InThe Platform Splits Down the Middle Coming InThe Platform Stays Solid Coming InLowered FloorUplift Style SeatingPlease indicate any information you can about the Conversion Upfitter, the Product Name, Series Info and/or how long ago it was upfitted for wheelchair access. If you have ordered a SINGLE Buyer's or Seller's appraisal within 30 days of your last purchase, please provide the reference # on the previous Appraisal to receive the $14.95 discounted price. Or provide the reference # on a previous COMBINED Appraisal within 30 days of your last purchase to receive the $22.95 discounted price.Consider the following (see below). On a Scale of 1-10 (10 being highest), please rate the vehicles conditionConsider the Items Below:Submit