NDIS Equipment Inquiry Thank you for your inquiry. Request information or a quote by filling out the form below and we will get back to you as soon as possible. Please ensure you have completed, signed, and attached the Service Agreement Form relevant to your purchase type. The forms can be downloaded from our NDIS page. Business Hours Monday to Friday: 8.30am – 5.00pm | Saturday and Sunday: Closed | Public Holidays: Closed Your First and Last Names* NOK or Representative Name (if applicable) Your Email Address* NOK or Representative Contact Number Your Best Contact Number* NDIS Support Coordinator Participant's First and Last Names* NDIS Support Coordinator Contact Number NDIS Number* NDIS Support Coordinator Email Address Participant's DOB* Therapist Participant's Residence Name (if applicable) Therapist Contact Number Participant's Residential Address* Therapist Email Address Delivery Address* Quote Type (Hire or Purchase)* Participant's Contact Number* Hire Period (if applicable) Your Message IMPORTANT: Please specify which product/s you are inquiring about. If requesting a quote, please specify attributes in this section to ensure accurate quoting. e.g. size, style, colour, orientation. Funding Self Managed Participant can pay by credit card (VISA or MasterCard) or via Electronic Funds Transfer (2 weeks hire paid in advance). Plan Managed Equipment Hire: Written confirmation from the plan manager that the participant has sufficient funds in their plan to cover the hire costs and billing information are required. NDIA Managed Quote required stated supports are to be approved and a service booking created by the NDIA. Rehab Hire can create a service booking for no quote required stated supports. Refer to the NDIS Support budgets in your plan for more detailed information. Please upload your completed Rehab Hire NDIS Service Agreement Form by clicking the button below.