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CUSTOMER DETAILS

* Indicates required field

FIRST NAME *

LAST NAME *

PHONE NUMBER *

SECONDARY PHONE NUMBER *

CARD HOLDER NAME PAYEE *

Card Holder Phone Number *

Will you be the card holder putting the ride Oder in *

YES NO

UPLOAD ID Helps verify real rides *

Max file size: 20MB

SPECIAL INSTRUCTIONS *

Email *

HOW MEANY PASSENGERS *

PICK UP ADDRESS *

LOCATION TYPE PICK UP *

ADDITIONAL ADDRESS INFORMATION *

APT NUMBER *

CITY *

STATE *

COUNTY *

COUNTRY *

ZIP CODE *

DROP OFF ADDRESS *

DROP OFF LOCATION TYPE *

CITY *

STATE *

ZIP CODE *

COUNTRY *

COUNTY *

Customer Bank Name *

Name *

First

Last

I HAVE READ THE TERMS AND/CONDITIONS *

YES NO

DATE *

PAY NOW

PAY REGULAR
PAY NOW

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PAY LATER

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.We’ll send reminders, so you never miss a payment. And if you do, we pause your account until you’re back on track. There are no fees when you pay on time. And late fees are capped at 25% of the purchase price

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see your spending limit, and keep track of your favorite places to shop. And get alerts on new launches and offers from top brands. It all happens on the app.

CUSTOMER DETAILS

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