Online Application

Fill in the online form, print it and take to your dealership for their signature prior to submitting for vehicle equipment reimbursement.
Or, you can print out a blank form and provide the required information and dealer signature.

Required documents for reimbursement approval

• Completed application form
• Copy of vehicle registration
• Copy of itemized paid invoice from adaptive equipment company
• Copy of signed Buyer’s Order or Lease Agreement
• Original prescription/letter from a licensed medical doctor when required (see item #3)

DriveAbility Program HQ
Troy, MI 48007-5080

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