Application for Senior Club

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The Senior Club is a specialized program designed to support elderly passengers by offering discounted rates and vehicles tailored to their unique needs. Our fleet includes lower, easy-access vehicles to ensure comfort and convenience, while our top-tier professional drivers provide a safe and accommodating experience. This service is aimed at making transportation more accessible and comfortable for seniors, ensuring they receive the care and attention they deserve during every ride.

PLEASE READ CAREFULLY!!!

Thank you for submitting the preliminary application form. Please note that this form is not a confirmation of an application, but rather an expression of your interest in creating an account with us. The information provided will be used to draft an application tailored to your specific service requirements.

Should you wish to discuss any details further, please feel free to contact our Director of Accounts, Mary Price, at 718-591-7000 ext. 205 or via email at mepriceskyway@gmail.com.

We appreciate your cooperation and hope that our services will meet your expectations. We will keep you informed of any updates and will reach out to discuss your preferred billing method in the future.

Name of Applicant *

Are you affiliated with an organization? *

Yes

Provide contact information of organization or person filing for the Applicant. *

Phone Number of Applicant *

Email of Applicant *

Secondary Contact Information (If we can not reach you, please provide a secondary contact and provide what we can share with that individual) *

Pick-Up Location *

Drop-Of Location *

Reason for Trip *

Business

Personal

Other

Will a wheelchair accessible vehicle be necessary? *

Yes

What type of walking apparatus do you have, if any?

Rollator

Rollator with Walker

Motor Rollator

Walker

Upright Rollator

Walker with Seat

Foldable Wheel Chair

Clear selection

Will the Applicant be traveling with an Aide? *

Yes

If Yes, then how many aides ? *

Will the Applicant have a portable oxygen tank? *

Yes

Is the Applicant ambulatory or non-ambulatory? *

Yes

Is the Applicant being transferred from one facility to another? *

Yes

Is it necessary for the Applicant to travel in a low vehicle? *

Yes

If an account is established, would the Applicant wish to have Auto-Payment? *

Yes

Submit

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