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Accessible Vans of America, LLC (AVA) agrees not to disclose any of the information contained in this Preliminary Information and Personal Application for Membership to anyone outside of the organization and assures the applicant against invasion of privacy by other parties or applicants.

Application for Membership

Please answer the following as thoroughly as possible. This information is vital in helping us determine if AVA and yourself share a common set of goals and beliefs.


Company Contact Information
Company Information

Officers and/or directors of the company:

Company Locations Information

Do you have other locations:

Company Products and Services Details

What service(s) do you provide? (e.g. Mobility Equipement Sales, Services, Used Vehicle Sales, DME, Para Transit, Driver Training)

What vendors do you represent? (e.g. Braun, Bruno, El Dorado, Quickie IMS, Vantage)

What unique products or services do you provide?

Company Size Details

Is there a 24-hour support to any of your numbers? (e.g. answering service, voice mail) Please provide details includeing phone numbers.

Do you or have you ever, rented wheelchair accessible vehicles and/or wheelchairs and scooters?

Do you have insurance on your rental fleet?

Do you currently use any software to track your profit/utilization on your rental fleet?

What most interests you about AVA and becoming a member of AVA?

What geographic area are you looking for?

What major airports would you service?

Do you have the ability to obtain $150,000.00 in vehicle financing?

How many vehicles do you forsee having in your rental fleet

Predicted on mutual acceptance, what date would you be able to begin renting?

What Professional or Trade Association memberships do you have? (e.g. NMEDA, NMTA)

Other information members should know about your business and/or services.


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