Document request - nikodrive

We also mail brochures to our customers.
We apologize for the inconvenience, but please apply using this form.

name

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Telephone number

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*If there is a problem with your e-mail address, we will contact you by short message. We may also contact you to ask about your situation and symptoms.
Email address

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*Caution There is a possibility that the e-mail address of the mobile phone will cause a transmission error. We will send you important information, so please enter the address of your computer or cancel the cell phone mail filter. Domain "nikodrive.jp" removed from restrictions

Private/corporation

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individual corporation
Sex

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Male Woman
Era

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Disease name

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Disability name/grade

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Reason for requesting materials

Required

1.Considering purchasing the product alone 2.Comparing with other company's products 3.Considering purchasing when changing cars 4.I want to know the information first because it is my first time to drive manually. 5.I want to introduce to my family and friends 6.want to introduce to patients 7.others
Required materials

Required

1.product brochure 2.Basic information on subsidies etc. 3.Compatible size chart

The following materials are PDF data.
Please check the desired PDF document and we will send you a link to the PDF data document by automatic reply mail.

1.Guide to safe driving 2.Operating instructions 3.Publication 4.Driving assistance equipment catalog DRIVE 5.Disability Discrimination Elimination Act pamphlet (easy-to-understand version) 6.Notification of the Disability Discrimination Elimination Act regarding the use of rental cars 7.Application results for automobile remodeling subsidies
Do you have any concerns?
What do you want to use the hand control for?
Where did you hear about it?

Required

1.Search on internet 2.Hospital 3.Event 4.Magazines and newspapers 5.Acquaintance 6.Others

検索キーワードを具体的にご記入ください。

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その他、どこでお知りになったかをご記入ください。

*The personal information you enter will be managed by nikodrive and will not be provided to third parties without your consent.

Document request application form