Cash or Credit

We know the Power Mobility paperwork that insurance companies require can drive you crazy. That is the exact reason that GoAssured.com offers the same Power Wheelchairs and Scooters at rock bottom cash prices.

If you would rather not go through the Medicare or Insurance billing process you can buy a new power chair or scooter from us over the phone or through the web from our secure, convenient online store.

Our professional, courteous sales staff is ready to help you find the perfect product to meet your needs. Looking for an accessory or lift for your power chair or scooter? We offer a full line of products and accessories to help you stay safe and independent in your own home. Best of all we Accept all major Debit or Credit Cards

General Information
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone Number:
E-Mail Address:
Best Time To Call:
Do you have Insurance that will help pay for the cost of a Power Mobility Device?	Yes No
Do you have Medicare as your primary insurance?	Yes No
Without the use of any type of mobility equipment (e.g., cane, walker, Manual Wheelchair) are you stumbling, falling or having difficulty getting around inside your home?	Yes No
Yes, I would like to receive future communications from Assured Medical Supply.	Yes
Are you a current Assured Medical Supply Patient?	Yes No Please make a selection.