Transportation Referral Form
Mass Transportation Authority
1401 S. Dort Highway
Flint, Michigan 48503
(810) 767-0100


Date Sent:


Fax to: (810) 237-8712
 
(Please allow two weeks notice before the date of event)
Date of Event:
 *
Name of Group/Organization: *
Street Address:
*
City:
*   State *  Zip *
Contact Person:
*
Phone #:
 *   Fax #:
Pick Up Site #1:
 *
Departure Time:
 *
Departure Site #1:
Arrival Time:
Pick Up Site #2:
Departure Time:
  
Departure Site #2:
Arrival Time:
Pick Up Site #3:
Departure Time:
Departure Site #3:
Arrival Time:
Number of Passengers:
*Do you need a Wheelchair Lift?
Yes No

Number of Wheelchairs:
Special Instructions/Comments:
Local transportation is $1.25 per person per one way trip. Regional transportation is $2.00 per person per one way trip. Additional fare info will be provided upon request.
Payment must be submitted to the MTA Administration Building at least 24 hours in advance of trip date. (Please call and confirm trip 3-4 days prior to event)
I have read and agree to the terms stated on this page. *
Signature:
Date: