Book a Limo Form

Book a Ride

Please complete the form below to arrange for courier transportation for elderly pick-up. If the requested date is unavailable, we will notify you promptly.
Full Name

First NameLast Name
E-mail
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
No. of Passengers
Vehicle

Transportation Van
Pickup Date & Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Pickup Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dropoff Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Comments
My Products
prevnext( X )
BASIC PLAN
4-6 round-trip rides/month ·Local trips (within 10 miles) ·Scheduling at least 48 hours in advance ·Add-ons: $20 each additional ride ·$40 for weekend

$300.00



Standard Plan
Wheelchair Access 6-8 round-trip rides/month ·Wheelchair van with lift access ·Wait times up to 30 minutes included ·Priority booking during business hours ·Add-ons: $45: ride /$60 stretcher (if needed)

$500.00 Quantity



Premium Plan- Stretcher
Gurney Transport 4-6 round trips stretcher transport ·Up to 20 miles per trip ·Includes weekend and holiday service ·Family or caretaker rides ·Add-ons: $80 per extra trip and $120 for longer wait times

$800.00



Basic Range
per mile during normal business hours

$8.00



Basic Range
per mile before and after business hours

$17.00



Basic Range
per mile during holidays

$20.00



Basic Range
per mile additional attendant fee

$10.00



Ambulatory Service
during normal business hours

$50.00



Ambulatory Service
before and after normal business hours

$80.00



Wheelchair Service
during normal business hours

$70.00



Wheelchair Service
before and after normal business hours

$90.00



Stretcher Service
During normal business hours

$150.00



Stretcher Service
before and after business hours

$250.00



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Book a Ride