Delaware City FLEX Request
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FLEX TRIPS MUST BEGIN AND END WITHIN DELAWARE CITY
FLEX OPERATES MONDAY THRU FRIDAY 6 AM TO 6 PM. LAST TRIPS SHOULD BE RECEIVED BY 5:40 PM FOR SAME DAY PICK UP. REQUESTS WILL BE ACCEPTED FOR A TRIP UP TO FOURTEEN DAYS IN ADVANCE. ALL TRIPS ARE SUBJECT TO AVAILABILITY. ALL QUESTIONS MARKED WITH A RED ASTERISK (*) MUST BE ANSWERED. THANK YOU FOR RIDING FLEX! MASKS ARE REQUIRED TO RIDE.
First Name *
Last Name *
Phone Number (including area code) *
Date of Birth (MM/DD/YYYY) *
Date of Trip *
MM
/
DD
/
YYYY
Address (MUST be in Delaware City) *
Address (MUST be in Delaware City) *
Requested time to be picked up (if arrival time is more important, leave this time blank and put the time in the appointment block below).
Time
:
APPOINTMENT TIME (IF NEEDED-- pick up times will be based upon arriving by this time )
Time
:
Return time (if you want a ride home)
Time
:
ANY SPECIAL MOBILITY REQUIREMENTS (i.e. wheelchair, walker, requires lift) Please review the IMPORTANT INFORMATION at the bottom of page to make sure FLEX is the right service for you
REASON FOR TRIP *
EMAIL ADDRESS (FOR EMAIL REPLY *necessary for confirmation of receipt of request)
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