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Viewpoint Van Conversion Order Form

The form below is for Authorized Viewpoint Mobility Dealer Use Only

If you are an individual interested in a wheelchair accessible van conversion, please contact us via our Web Form  or call us toll-free at 1-800-561-9600. We'll be happy to answer your questions and direct you to a dealer near you. You can also contact a dealer directly by searching our Dealer Locator.

Please submit the information below. You will receive an order confirmation via email and be able to print your order once submitted. If you prefer to submit your order via fax or email, download the pdf.

A Viewpoint Mobility representative will contact you regarding your order within 1 business day.

VERY IMPORTANT:   Options are vehicle dependent. Please  confirm what options are available for your vehicle by reviewing the conversion options chart.

Dealer Information
Client Information (for warranty registration - if known)
Conversion Style: Refer to Options Chart for Power or Manual Conversion Eligibility
Conversion Length: Refer to Options Chart for Conversion Length Eligibility
Short Conversion:
Long Conversion:
Seating Options: Refer to Options Chart for Seating Options Eligibility
Relocate OEM (factory) 2nd Row Bucket Seats
Viewpoint Mobility 2nd Row Narrow Bucket Seats

Important Considerations:

1. Additional surcharges may apply if vehicle has been damaged due to collision or corrosion.

2. Please ensure all personal property and/or additional seating is removed from vehicle prior to conversion.

3. Viewpoint Mobility can only modify 2004 and (newer), front wheel drive vehicles.

4. Minimum 50% Deposit Required prior to conversion commencement.

5. Order Confirmation will be sent once an order form has been submitted.

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