Request Form

Request Form

Let us know how we can help you!
Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a current member of ODBC?*

YesNo
If not, how did you hear about us?
Example: Drove by, Online, Family member, etc.
Please select your request below:*

Fellowship Hall ReservationChurch Van/Bus ReservationChurch Trailer ReservationOther
Purpose of request? *
Example: Baby shower, Birthday party, Youth trip, etc.
Beginning Date:*

MonthDayYear
Date
Beginning Time:*

Hour Minutes

AM/PM Option
End Date:*

MonthDayYear
Date
End Time:*

Hour Minutes

AM/PM Option
If you are requesting the use of church transportation, you must answer the following questions before submitting this form.
1. Have you been involved in a motor vehicle accident in the past 3 years?

YesNo
2. Have you had any moving violations in the past 3 years?

YesNo
If any of the following questions are answered yes, the driver may be ineligible.
3. Have you ever had an insurance company cancel or refuse to provide you with personal auto insurance?

YesNo
4. Have you ever had your drivers license revoked, suspended or restricted?

YesNo
5. Have you ever had any physical or visual impairment other than corrective glasses?

YesNo
If you answered yes to any of the 5 questions above, please explain:
Should be Empty: