CARE-A-VAN Services, Inc. Electronic Cancellation Request
Use this form to cancel scheduled transportation services at least 24 hours in advance. Do not use this form to cancel appointments scheduled less than 24 hours away. Contact CARE-A-VAN Services, Inc. at (575) 397-2801 to cancel less appointments less than 24 hours away. Last minute cancellations will incur a cancellation or no-show fee.
Travel Date *
Enter the pick up date here.
MM
/
DD
/
YYYY
Pick Up Time *
Enter scheduled pick up time here.
Time
:
Passenger Information
Passenger Name *
Passenger Name
Your answer
Pick up City *
Your answer
Pick up State *
Destination Information
Destination City *
Please enter the name of the destination city here.
Your answer
Claimant's Destination State *
Guarantor Contact information
Please enter guarantor information below.
Name of Company/Guarantor *
Please enter the name of the company or guarantor here.
Your answer
Name & Title of Person Submitting this cancellation request. *
Please enter your name and title here.
Your answer
Phone Number of Person Submitting this Request. *
Please your phone number here in case we need to reach you for additional information.
Your answer
Email address of of person submitting this form
Optional
Your answer
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