Vehicle Pick Up Form

Vehicle Pick Up Form

Please provide the requested information in the fields below to get started.
Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Group Number (GIN) *
Vehicle Number *
Reason for pick up: *

New Group Primary Driver Change Upsize/Downsize Mileage Equalization Other
Will you be the public contact for anyone interested in joining your vanpool? This person's contact information is listed publicly on RideshareOnline.com and PierceTransit.org. *

Yes No
If yes, please list the email and phone number you would like to share on RideshareOnline.com and PierceTransit.org.
Email
example@example.com
Phone Number
Please enter a valid phone number.
If no, please list the name, email and phone number of the person who will be the public contact for your vanpool on RideshareOnline.com and PierceTransit.org.
Name

First Name Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Pierce Transit has confirmed that your vehicle is clean and ready to use. Unless otherwise noted, items listed on the Pierce Transit Vehicle Inventory List will be issued with the vehicle.

Please let us know if you see something we may have overlooked, including the cleanliness of the vehicle or missing items listed on the inventory list.
Please enter the odometer reading:
Does the vehicle have any noticeable damage? *

Yes No
Are the items listed on the inventory list in the vehicle? *

Yes No
Please list any noticeable damage, missing items, or other concerns: *
What did you receive? (check all that apply) *

Key Remote Combo
Key
Please enter the number of keys you received.
Remote
Please enter the number of remotes you received.
Combo
Please enter the number of combos you received.
Acknowledgements
My signature below signifies that:
- I am receiving the vehicle listed above in the condition stated on this form.
- I agree to return the vehicle in the same or acceptable condition, as determined by Pierce Transit.
Failure to comply with the terms of this agreement may result in termination of your vanpool group and/or charges for damaged or missing items listed on the inventory list.
Signature *

This form will not be accepted without a signature. Clear
Date
Should be Empty: