Customer Photo Upload Please upload and submit one photo of the product sold and one photo with the customer(s) and salesperson in front of their new product. These will be used for social media posts and other marketing initiatives. Please make sure to have the customer sign a photo consent form upon delivery before the pictures are taken. Thank you! Salesperson Name First Last Mobility Center Location*ClevelandColumbusDaytonCincinnatiCustomer Name* First Last Product(s)* Wheelchair Van BaunAbility Ford MXV ATC Truck Scooter/ Powerchair Lift Wheelchair Lift Valet Seats Hand Controls Foot Controls Driving Aids Transfer Seats Braun ChairTopper Paravan Controls Access A Top Stairlifts Vertical Platform Lift Other Please indicate what products the customer purchased and/or got installed.*Please specify.Scooter/Powerchair Lift Model*JoeyCurb-SiderSpace-SaverChariotOut-SiderOut-RiderBack-SaverWheelchair Lift Model*Braun MilleniumBraun CenturyBraun UVLVMI ReliantVMI KlearvueVMI ClearwayVMI Slide AwayValet Seat Model*Valet PlusValet LimitedValet LVHand Control Type*Push RockRight AnglePush PullRight HandFoot Control Type*Pedal GuardPedal ExtenderDriving Aid Type(s)* Spinner Knob Multi Function Buttons 4 Way Switches Multi Function Spinner Knob Gear Extension Turn Signal Crossover Parking Break Extension Stairlift Model*Elan Straight RailEilite Straight RailElite Curve RailOutdoor Straight RailOutdoor Curve RailCustomer's Story*Please give a brief description of the customer's need that we are filling with their new product.Photos Drop files here or Please upload two photos. (1.) Photo of Product(s) sold, (2.) Photo of customer(s) and salesperson in front of new product.Did you receive a photo consent form signature?*YesNoConsent Form* Drop files here or Please upload a picture or scanned document of the signed consent form.