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Please enable JavaScript in your browser to complete this form.Your Name *FirstLastEmail address *Contact Telephone Number *Name of the End User *FirstLastAddress of the End User (First Line) *Second Line of AddressCity / Town *CountyCountryPostcode **DECLARATION FOR THE VAT RELIEF*: If you or the person you are buying on behalf of is eligible for VAT Relief, please choose one or more option from the list below. By selecting one or more options below you agree to the following: You are a registered charity or are chronically sick or disabled or the products are being purchased on behalf of an individual who is chronically sick or disabled. The product being supplied by SHEEN MOBILITY is for personal or domestic use. You claim that the supply of the product is eligible for relief from VAT under the VAT Act 1994. If you are in any doubt as to your eligibility to receive goods or services exempt or reduced rate for VAT you should consult your local VAT office before signing this declaration. *Alzheimers DiseaseAddison's DiseaseAmputeeAnginaAnkylosing SpondylitisArthritisAsthmaBenign Prostate HypertrophyBronchiectasisBlindnessCancerCardiac ArrythmiasCardiac FailureCardiomyopathyChronic BronchitisChronic Obstructive Airways DiseaseCOPD - Chronic Obstructive Pulmonary DisorderChronic Renal DiseaseCoronary Artery DiseaseCrohn's DiseaseCryoglobinaemiaCystic FibrosisDeep Vein ThrombosisDementiaDermatomyocitisDiabetesDiverticulitisDysrhythmiaDystoniaEmphysemaEndocarditisEpilepsyGlaucomaHaemophiliaHeart DiseaseHypertensionThyroid DiseaseKidney DiseaseMotor Neuron DiseaseMultiple SclerosisMyasthenia GravisOsteoporosisPaget's DiseasePancreatic DiseaseParaplegiaParkinson's DiseasePhysically DisabledRespiratory FailureStrokeTerminally illOtherDescription of the Medical Condition *EmailSubmit
