Toyota Mobility Point of Purchase Materials
Description
Image USA II Poster (2mm sintra)
Description
Window Cling
Description
Brochure
Dimensions
W=29.75" x H=29.75"
Dimensions
W=22" x H=22"
Dimensions
W=8.5" x H=11"
MDC#
00690-POS11
MDC#
00690-WCL11
MDC#
00690-MCB10
Cost
$25.00 each
Price
$18.00 each
Price
$0.20 each
Retractable Banner w/ case
Description
Counter Top w/ 25 booklets
Description
25 Mobility Booklets
W=33" x H=85"
Dimensions
W=9" x H=12"
Dimensions
W=5" x H=7"
MDC#
00690-REB11
MDC#
00690-CBR11
MDC#
00690-COB11
Price
$295.00 each
Price
$17.00 each
Price
$0.20 each
Scio ASS n Mob iStA il nce ity Pro RAM grA E PROG M SISTANC ITY AS
App lication
(Ple
origin
ASe
ne W must VeH be com icl ple e
Al ret Ail
PROG
MOBIL
REIMB URSEM MUSt
bers ted and ENT t or cUS be nam tyPe APPLI toM e: ___ submit ADAPt ) family mem er AnD ______ CAT ted wit eD Wit and/or ION VeH ______ icle owners FOR hin 90 Hin 12 ___ inForM Pho M s day Mo of Lexu Prin
Daytime
E SISTANC ITY AS
RAMAddress: ___ ne number: _____________________
Atio
n
s ntH s of need mobilityvehicle S oF Del LUDE:
bilities. ical disa with phys
Scio ASS n Mob iStA il nce ity Pro grA PROG M
bursement
of up to $1,0
00
adapta ______ ______ ports the ______ iVery ______ th a cash reim tion Sup______ ______ ______ liSt ______ by orig DAte vehicle buyers wi ______ ____ All ______ ing: ADA ADA ______ inal retail city: ______ PtiV cePti Ve verted Lexus rted ______ ______ veh rred for the follow e eqU ______ ______ stan eqU ______ ssible conve iPMele con ____ s incuicle ______ cessib ______ ______ ility Assi purcha nt inSt iPMpense ______ ent lchair-acce e-M s Mob ______ elp of fset ex nt ser ______ ______ Alle ______eelchair-ac SUM ail: ___ nd/or whee . D: ___Lexu MAruipme ______ ______ _____ s new or wh ______ ______ Supp il buyer) to h nly to new a e mobility eqy DATE ______aser. ION FORM ____ vehicle Provide e reta ___daptiv ______ Vehicle ort0 per ______ ______ ly to th e purch ______ State: ying a DELIVERY ffer applies o APPLICAT s direct___ ______ ______ iden ______ ______ THS OF by original vehicl ______ ___ (paid ximum $1,00 the mo ion of qualif ibility. This o tificatio SEMENT stallat _ ______ ccess ______ ______ _ Zip: ation ______ IN 12 MON ARY bility rements; ma d/or in___ ______ REIMBUR ______ ______ heelchair a ______ Purchase an SUMMn number ______ ______ TED WITH of vehicle adapt ___ tailed requi ______ MENT need • ______ equired for w ______ for de days (Vin ___ EQUIP BE ADAP ______ n form___ ______ > Sc ___ ___iles. ): s of rsion r___ VehicleLLED: __ within 90 799 m ______ ADAP TIVE LE MUST licatio ___ ___ conve tted ______ ___ ___ s than ______ Scion ion ______nt app T INSTA Mod ______ ______ ___ ___ • Vehicle______ ith les ___ NEW VEHIC leted and submi UIPMEN el: ___ ______ ______eimburseme ______ Provide Mobil ______ owne ______ TIVE Eq ___ ______ ity vehicles w comp custom ______ __ ______ L ADAP N ity As mobil ______ new elines and r ______ ______ must be LIST AL rs an ______ MATIO to $1,0 s new er Sign ______ ____________ Scio tached guid sistan ______ ______ ____________ LE INFOR Application ___ or d/or ______ ___ n ion 00 ______ Veh atur VEHIC ___ ______ ______ ______ (paid wheel d-term ______mat ______ __ e: ce efer to the at icle family RDat ____________ MER AND • Pur ____________ ______ ______ diretendechair-a nt e of Ada (VIN). Mileage ______ ______ urce Infor ___ ______ ____________ L CUSTO ___ chase Reso uipmecce memb : ___ s flexible, exctly ___ ______ a.org. ______ __________________ ID number ptation/ ____________ NAL RETAI to the ______ ssible ____________ and/or __ ______ ORIgI adaptive eq Mobility www.nmed • Vehrovide stalled E) _________ lers. P tota ______ ers wi vevers ____________ reta ______ OR TYP ______ l Actu ______ ____________ icle ensicon ____________ install the in mobility and il buy conver ___ Scio______ E PRINT g Lexus dea le with ___g preh con ion com ______ th ph al cos (PLEAS _ (MUS______ n DeA ______ ______ ______ ___ ted ncin ation er) to ____________ .lexus.com/ participatin Lexus vehiccon ____________ t be verted version t: $ ___ AmoCom ysical ____________ plet†ion: ler ___ ________ ______ ervices and help Scion reta ility Fina ____________ coM ble at www new ____________ unt SHiP ____________ ______ ________ mobili require of qualify Mob Ple of reim Availa Date ______ offs [$1,0 ____________ ncial S_____ urchasing a tails. refer _____ disab ______ ______ teD Dea inF il ices Name: _____ 00 : s Fina ______ for de ______ ___ ___ ty ______ by tHe______ burs orM Maxi lership vehicle d for whs ing adaptiv et expens vehicle h Lexu/______ amilies, for p exus dealer l Serv______ ______ ilities mum eme per vehto the atta _______ _ /____ ncia ____________ e Number: __ ____________ Selling Ation______ nam nt req es incu buyers Fina /___ /___ roval, throug ______ ies or their f s witehicle eelcha e mo ____________ sAvail . AnD Dealer ______ e: ___ able icle iD chedting Motor V _______ ____ ating L uest _ Daytime Phon DeA wit for eachit app bility cer ___ ir acc ____________ less ocal particip rred :* $ ____ical disabilit___your l > Co ___ ler Lexu ____________ “Adap guidel ese stheps: code: ____________ RAV4 num tiFi ______ ______ le upon cred ____________ SHiP /______ ______ chure equ ______ Vehic h phys tha ess for theh a cash ______ ntact cAt vailab des th ______ ine ___ __ ns wit ____ ______ ber _ A mp ) he bro coP n 799 ipment e: ___ ibility. le _______ ADA ______ ion PtiV ying for s and ______ /______ ed in t reh rocess inclu ____ _____ (Vin num ase co followi reimbur Address: oF perso n costiDs). Ple ______ detail mil Ava i HAV ____________ ehicle Mileag this _______ ber (Vin ____ ). en reim The p e eqU tHetallatio financ tion: ________ ______ ____ sem ng: offer a.gov. ___ bursem es. New Lexus V e exA cess, which is w.nhtsilab ________ Zip: ).] le at sive Mo ____________ __________ iPMentPAiD rec ____ ___ ing ins ent of rsion Comple ______ ______ applies MineD ______ www.n ____ mended pro AnD Conve at ww (includ _______ > AttAcH _____ State: __ eiPt ______ ____________ bil ent /co up ___ 36 or tation/ _ ecom ______ it HAV ______ Sc ity ______ tHe ______ eqU ___ applica ______ only meda. iS NEW ion Fin eD to nVerSi (S) Det E YOU eqU______ elig Date of Adap iPMent 88) 327-42 portation’s r VEHICLE to new ____________ _____ ____________ ____________ Aili ___ tion org. Resource iPPeD Trans ible tHiS on AnD PRO MUST ______ Availab highlander ng tHe by calling (8 ___ ancia BE DeS form City: _______ includ ADAPTE VIDED: Application and/or Scio ost: $ _______ ____________ clA ent of VeH______ ______ D WITHIN WitH ______ ilable cri copy must n Dea ents iM ForcoS icle for det be completed re ava tS MUS beD _______ es list Inform U.S. Departm extend le upon l Servis. 12VehMONTH tHeVIN).] Total Actual C wh ____________ irem __ of ler pies a iDe and rts the uest:* $ eel M. on submitted ______ S requ umber ( ailed OF DELIVER Author s of mo ation creditr need ces † s.” Co Y t be ent Req icle suppo chair-a within 90 days ): tHe ADAPtiV ntiFieD E-Mail: _ _________ ______ Original with ed-term bursem Lexus license DATE require Sale ith Disabilitie er (VIN izedach Vehicle ID N retail copyof vehicle bility e Mob Abo t of Reim the insuited to you ccessib s or ble for e SignCUStOMerAtt AcHVeHiCle ____________ fina approval, Mobil Amoun ___ (PLEASE ople w driver’s cation Numb and of invofor Peadaptation m Availa Ve, ments leaseby original vehicle equipm PRINT OR TYPE)atur dealermost s ___ eD rec ilit ity Fin installe talled ncing Maximu inFOrMati ___ le throug state’s purchaser.* ____________ y ______ e: ice Det equipment ILINg ThE Prin [$1,000 Agr Vehicle Identifi On ; T bE ______ for ma for odel ______ ent your eiPt ______ aptive ) DETA d ada eem t e S MUS an Author per ximum details ailin rmin exus m h toy dealers ______ adaPtiVe (S). ptiv cing Name: _____________ ______ID RECEIPT(S AND COST ____________ g Mob eQUiPMenent entify the ad LIST ALL ADAPTIVE ized _____________ Pro . ine thee best L t SUMMarY equipmsons wit ota Fin $1,000 ____________ 1. Dete s ______RSION and ______ SignY OF ThE PA EqUIPMENTility _____________ of RM. ur area to id ____________ eterm INSTALLED: Mod need Toyota install A COP ature: ENT/CONVE ent (inch physica ancial Ser ____________ _____IM FO _________________________ equipmof custom ___Daytime Mobility ifica ment dealer in yo Scionl Lexu s dealer to d Phone ___ TIVE E Assistan qUIPM O ThIS CLA ers, l: _______ _____________ Number: uate your equip Date tions er Pay ent ______________ hED T ce luding l disabili vices and Provides _____________ Eval ____ r loca sup listed : ___ or equ ______________ ______ 2. ADAP___ _____________ Vehicle Mode ATTAC obility _____________ ports new or wheelchair-accessibl menct a m ____________________ All _ /___ install ties ____ /_____ /_ title:___ Address: ______________ by sta ller and you“Adapting t in Full ipment _____________ ______ mbers to $1000 the Sign _ /___ e converted _____________ ______ _______ ation or the particip (paid ______________ the Conta_____________ re me te. _____________ atur ipment insta ______ Date: _ Toyota for Mod t vehicle er Signature: ______ _ ______________ they abuyer) retail vehicle ir ating procesMotor Veh U.S.directly the retail es (inc cos ______ Depart toonfirm Custom ______________ _____________ daptive equ buyers ION ____________ _____________ ts). Ple familie ifica r, an a ______ _______les _____________ Sci a cash reimbursem with • Purchase luding ice. C icle : s incl _____________ ___ ct the righ tions ____________________ toyo mentstablished vehicleto help offset expenses sor lett and/or d serv CERTI FICAT aluato s for installation ____________ ___IDED _____________ for pur on _____________ ___ ase cons,for ta Moto dealers incurred 1. custom ude ent of up ge an 3. Sele or _____________ t ___ N AND ller ter• Vehicle _____________ or effic of of qualifying Peo has e er of s the n that _____________lled YOU PROV ______ se Agreemen following: r City: ______________ with your ev MATIO __________________________ ____________ ______ adaptive mobility er ple with tra tact the cha anty coveraconversion _______ nt insta De HAVE ______ ) nsport mod iency Sale Author INFOR se ste required s. izatio sing . Provide lice _____________ or Lea ______________ izat Consult nam ERShIP _____ pme of s, U.S.A your ifica equipment RSHIP ___ nt Insta for _____________ e, add ience, warr mi nse ne organ __ State: wheelchair ______ accessible ______ equi g DEAL tions adaptive ., inc.f Vehicle Sales ation’saccessibili ps: Disabil DEALE __________ et your need other 2. s local a new ns or Equipme_ (when d Med ______ toyo your converted ion _____________ does SELLIN ress com _____________ to me LExUS Evalu equi ) or an ty. This offer applies dificatio E-Mail: Copy o tA Moto ______ Zip: __________________ mobility vehicles (for leas bY ThE mobilityons, capabilities, exper MEDA with ply ical particip Scion flexible, ities.”with ______________ rec and_____________ pme not assu req • Retail purchase ____________ ProgrAM _____________ state’s PLETED ______________ er om r uired) Doc only to new and/or ent g Mobility Mo on (N con ate ______ _____________ veh less me resp appl nt or insta cop bE COM ed qualified Vin) lificati_______ ____________________________ than recov tor Vali _____________ me799 of the Toyota WitH SAleS, atin Equipm * Detailin ____________ icabl (MUST ______ you ies are wheelchair U.S.A ndedmiles. ut qua oUt Vehicle Sienna tact Toyota _____________ driverfor as ose aveh nvoice rs Associati g Sci icle icles) reim e gove llation, onsib sistance to equipped noti ., C sk abo_____________ 11-Fl Identification odifications or _ ___________ Cho opy of I Deale ____________ ility a mo rMobility ____________ proces burs need Assistance withava New Toyota Vehicle 4. dati on on on inc. and ce. reSe rnm _______ t-051 the and a Number ment for the ull for M ame: _ factory-ins ation ’s ______ eme 3. (VIN): is cann ent will rVeS bili 17 ilab round Mileage: bein be automatica ent in F ot Physicia obility Equip lice applic s Toyota ______ Selec nt submitted s,talled ______________ ty by ched tHe er Paymsafe g paid nt will not le by Dealership N guar quality, wh Auto Access Seat. Note: lly processed VIN) the nse ____________________________ 4 Shop a e atta safe AbOVE, _____________ for CustomrigHt to ty standard ante ess and n’s ____________ dealer and calling based _____________ ipm be mad t the mit thequ Date The or reim uponich of Adaptation/C ty e that National M equi letterh is new conpme __ willreq _____________ MoDi the ent dea be paid Proof of s.e, addr detaile MENT of theCompletion: IDENTIFIED nd sub ards. : ___________ vehicle sales record $1000 _____________ uir directly to the such obtain Fy orer nam sult Refer burs e in caseonversion (888) toht rig the attached and Kee stand________ ead custom _____________ em ed by VEhICLE retail buyer. terM Vehicle Model: wit LITY EqUIP of the new comp ler in and guidelines (RDR) Scion lete a P_____ Dealer Code 327-42 d in the to check /________ /_________ . vehicle ents veh h you anot s where inAte ______________ per conversion ELIgIbLE TIVE MObI oF recA coPy Total Actual Cost: tures (including you so be surereimbursement hicles) the use the guidelines and r conv ______________ased ve moersion tHiS icle e equipm ID number $her 36 or bro ______________ sour the equi application form ______________ All Signa INED ThE ThE ADAP hED RECEIPT(S). del to r evalua (VIN).ent, r area eiPt oF All ______________ ing on pme ce. ______________ 4. and/o ExAM at ww chure Customer Signature: follow for detailed requiremen Doc nttrain ______________ __ S WitAmount to ide SCIad orization (for le meet tion tor, of adaptiv I hAVE EqUIPPED WITh ThE ATTAC equipment Choose Compre H tHiS ofUMe etterhe ON w.nmaximum or insta Reimbursem an s complete, __________ ts; Obtain$ and/cess i ntify IS you Letter of Auth hensive htsa.go $1000 the installa 5. Request:** IbED ON APP ntS For ent llatio n Physician’s L 19001 CUSTOM[$1,000 Maximum r nee ada our adaptive AND IT Shop will approv the ada Mobility aAvailable is pro Lessor ______________ DESCR Available n st of y que ali at www.toyot 1 S. WE yoU for each v. ER ExP licAtion ds. ptive equ Resource Informa ______________ nies Vehicle ID Numberhe co__________________ or Validation o MAy ____ r When th ptivtion compa aro ______________ STE 2011 to: File AnD ignature: e equ ______________ leasing are me und and fied $1,000 of t ( VIN).] RN AVE ERI Medical Doct A COPY om.ent ____ /_____ /_ Includes ____ Date: ______ Not all ENC OF ThE PAID mobil amobility.cipm up to llation mbers MAi Authorized S install lists of mobility ipment ask Licensed ) RECEIPT(S) /______ establ E al. Note: /or insta NUE EqUIPMENT/ ADAPTIVE Toyota ______ Date: _ DETAILINg ThE ation. equipmentmo ent and /______ Financia tOYOta dealerSH , TOR CENTER CONVERSIO l coP Lexus Dealer er of the abo Corpor ieS lessor approv (when required dealers ishe ut qua ityl eq Service ____________ st suit and installers, listed r Credit N AND RAN , WC iP inFOrMati here the equipm uip s† Mobility and e written d veh Available COSTS MUST nat (MUST bE COMPLETED ATTAChED your lificapproval, cases w On and upon CE, CA by state. TO 10 bEby Toyota Moto 5. Ob ionalcredit ____________ ed to ThIS t to advanc icle e. CertiFiCat CLAIM made in ations, me bY ThE SELLINg local al first. nt insToyota Financin FORM. rk used gSci L iOnD MAIHAVE * Subjec tai er sourc __ ill not be 90501 your DEALERShIP) flexible,con approv vice ma ____________ by anoth extended-t YOU PROVIDED written ement w bilityfinancing versionMoerm capthrough s is a ser When n trainin taller Financial Services on dea ILE AN needs. bursed ____________ Dealership* Name: ature: Reimburs abi : Service or reim equ OUR F ______ and for Toyota ed Sign litie ____________________________ paid for Copy of Vehicle ler to FOR Y † Lexus Financial ipment persons g onvehicle withstathe ______ with physical disabilities participatin s, g Toyota dealers. assistathis pro is being ENTS Sales or ______________ N TO: Print Authoriz Lease Agreement rds. ces Provides the us ndainstalled adaptive ____________ erience participatin Dea exp Dealer Code: or their det erm ______ nce Copy of Invoice equipment ALL DOCUM APPLICATIO_____________ families, ______________ inefor purchasing (including installation PY OF to rec s is com g Toyota dealer for details. lers Detailing Mobility 00690-MAS ______________h ThIS ____________ ____________ L201 Associa , war a new Equipment Installed 11 90501 Modification ple e of over costs). Pleasethe bes KEEP A CO ECEIPTS WIT ______________ ______________ , CA____ s or ____________ ____________ * Subj FACTION, contact S OF R t your local up to te, followthe ne tion ranty cov ANCE ect to R SATIS COPIE Proof ____________ AL11 of Customer (nM iency $1,000 obta I hAVE ExAMINED CUSTOME AVENUE, TORR the gui w equip 00690-M Payment in Full eDA erage and in writ advance ____________ , safety or effic ch AND or Equipment ELIgIbLE for Modification of ERN VEhICLE ) or ano LExUS ThE † toyo ten appr writ Toyota IT IS EqUIPPED service s IDENTIFIED AbOVE, supports the U.S.the cos delines ment Title: ________ for the quality arantee that su . S. WEST ten less ta Fina ther oval 1900 1 WITh ThE ADAPTIVE MObILITY All Signatures and t of you Departmen or appr . DESCRIbED e responsibility, and cannot gu fety standards ncia first (including customer organi . confirm t of com tion’s EqUIPMENT Transporta NOTICE l Serv “Adapting . Motor ON ThE ATTAChED oval Vehicles and VIN) r ada ThOUT name, address oes not assum or installation government sa ices zation . Note for People with RECEIPT(S). RAM WI they Lexus d ipment ptive plete andrecommended process, which www.nhtsa is a serv plicable IS PROg : Not Disabilities .gov. The process that Toyota Dealer Lessor Letter of NATE Th equ .” Copies submitare available is detailed all leasincludes ice mar of adaptive equ omply with ap MAY 2011 Authorized Signature: R TERMI has in the brochure Authorization (for these steps: ipment ODIFY O ing com by calling (888) leased vehicles) used modifications c hT TO M Licensed Medical 1. Determkine and/or the atta 327-4236 or at by toyo pani ThE RIg es will ESERVES yourta Moto ___________________________ Letterhead (when Doctor Validation on Physician’s state’s driver’s conver ched app LExUS R appr required) ______________
MOBIL
PROGR
INC MENTS AM ELE
RAM
Assistance Pro ROAD gramG FREEDOM ON THE ININ
GA REIMBURSEM ENT APPLICATION PROCESS FOR VEN FORM A PRO
L=2.5' x 8' x 2.5'
MDC#
00690-TCL11
Cost
$350.00 each
fold
Dimensions
11-FLT-05
Print Authorized
118
Signature:
_____ Date: ______
/______ /______
INC. RESERVES
ThE RIghT TO
tOYOta CUStOMe TO: 19001 S. WeStern r exPerienCe Center, WC10 aVenUe, tOrranC e, Ca 90501
MODIFY OR TERMINATE
ThIS PROgRAM
MDC#
00690-MAS11 (Scion)
MDC#
00690-MAL11 (Lexus)
Price
WIThOUT NOTICE. 00690-MAT11
SS FOR GAININ
a mobility equipment
G FREEDOM
license the insta requirem sion. ents llati
ove
dealer in your
on of
area to identify
adap tive
$0.20 each
ON THE ROAD
lication
for
equi
pme nt, so the adaptive equipment
with your evaluator, an adaptive equipment Toyota model to meet your needs. installer and
is not required for the Sienna ** Reimbursemen Auto Access Seat t will not be made factory installations; in cases where reimbursement the equipment s will be automatically and /or
SALES, U.S.A.,
00690-MAT11 (Toyota)
3. Select the right vehicle Consult
be sure
your local Toyota
4. Choose a qualified mobility Shop around and ask about qualificatioequipment installer are
installation is being Toyota Motor Sales, paid for or reimbursed processed based upon the new U.S.A., Inc. does vehicle sales record. by another source. for the quality, not assume responsibilit safety or efficiency y installation, and KEEP A COPY cannot guarantee of adaptive equipment or OF ALL DOCUMENTS that such modification with applicable COPIES OF RECEIPTS FOR YOUR FILE government safety s comply AND MAIL WITh ThIS APPLICATION standards.
TOYOTA MOTOR
10-FLT-04534
4
MDC#
r cred 2. Evaluate your needs it corporation. Contact
If you are seeking reimbursement Mobility Assistance under the Program for a Sienna Rampvan braun conversion, do not use this application. Please dealer for assistancecontact your braun Rampvan form is not required to submit your claim. This as the Sienna Auto for factory installations such Access Seat.
__________________________ __________________________ ___________________ Title: ______________ ____________________________ ___________________________ * This form
4
Reimbursement Forms
Assistance Pro gram
A PROVEN PROCE
cut on
8' Table Cloth
most
suited to chec k and
to your needs.
dealer to determine
the best
1 members of the ns, capabilities National Mobility , experience, warranty established vehicle Equipment Dealers coverage and conversion standards. Association (NMEDA) service. Confirm they or another organizatio n that has
Cut on fold
Description
ELEM ENTS INCL UDE:
Description
Supports the mobility needs of Toyota owners and/or family member PROGRAM ELEME s with physical disabilitie A PR NTS INCLUDE: s. OVEN PROC ESS FOR GAIN ING FREE DOM ON TH E RO AD
fold
Dimensions
Cut on
Description
5. Obtain training When this process on the use of the new equipment is complete, follow assistance to recover up
to $1,000
the guidelines
and complete
and
of the cost of submit the attached * Subject to advance your adaptive application for equipment and/or written lessor sure to check conversion. and obtain written approval. Note: Not all leasing † approval first. companies will Toyota Financial approve the installation Services is a service of adaptive equipment, mark used by Toyota Motor so be Credit Corporation. 1
11FLT005 POS Sheet 10/11