Fill in the online form, print it and take to your dealership for their signature prior to submitting for vehicle equipment reimbursement. Or, you can print out a blank form and provide the required information and dealer signature.
Required documents for reimbursement approval
Completed application form
Copy of vehicle registration
Copy of itemized paid invoice from adaptive equipment company
Copy of signed Buyer’s Order or Lease Agreement
Original prescription/letter from a licensed medical doctor when required (see item #3)