Mountain Line Transit Charter Request Form

Please be aware that Mountain Line Transit, as a government agency, is subject to the terms and conditions set forth by the Federal Transit Administration (FTA). As such, Mountain Line must submit your request for transportation services to all private service providers deemed “Able and Willing” under FTA guidelines. Should such Willing and Able providers indicate their willingness to provide the requested transportation service, Mountain Line will be prohibited from do so in deference to this private business interest.

Please provide the following information so that we may evaluate your transportation request and provide you with an estimate for services:

First Name:		Last Name:
Street Address:		State:		Zip Code:

2nd Phone #:

Email Address:
Today's Date:

Date of Charter (must be requested at least two weeks in advance):

Number of Passengers:

Type of Vehicle Requested:

Trolley - 29 passenger
Goshen 30 foot bus - 23 passenger
Box Van - 12 passenger
Other Van - 10 passenger

Description of Service

Pick-up place #1:		Pick-up time #1:
Drop-off Place #1:		Drop-off Time #1:

Pick-up place #2:		Pick-up time #2:
Drop-off Place #2:		Drop-off Time #2:

Pick-up place #3:		Pick-up time #3:
Drop-off Place #3:		Drop-off Time #3:

Pick-up place #4:		Pick-up time #4:
Drop-off Place #4:		Drop-off Time #4:

Are a majority (at least 50%) of the passengers on this trip disabled?

Yes
No

Mountain Line personnel will contact you as soon as possible to discuss your transportation needs and indicate the availability of Mountain Line for the requested service.

Should you have questions or concerns, please let us know at (304) 291-RIDE (7433) or email us.

Thanks for considering Mountain Line!

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