AGENTPORTAL2

UTS Booking Form

Personal Information

First Name *

Middle Name (Optional)

Last Name *

Phone Number *

Email Address *

Date of Birth *

Who is this ride for?

This ride is for me This ride is for someone else

Rider's First Name *

Rider's Last Name *

Rider's Phone Number *

Preferred Contact Method *

Rider's Gender *

Who will be paying for the service?

I will be paying Someone else will be paying

Payee's Full Name *

Payee's Phone Number *

Payee's Email Address *

Payee - Street Address *

Payee - City *

Payee - State *

Payee - Zip Code *

Pickup and Drop-Off Information

Pickup - Street Address *

Pickup - City *

Pickup - State *

Pickup - Zip Code *

Drop-Off - Street Address *

Drop-Off - City *

Drop-Off - State *

Drop-Off - Zip Code *

Service Details

Service Type *

Add Special Instructions

Special Instructions

When would you like your ride? *

For Today *

Select Time *

Trip Type *

Return Date *

Return Time *

Would you like the driver to wait? *

How many minutes will you be at your location? *

Number of Passengers *

Notification Preference *

Please go to Google to find out how many hours and minutes it will take to get where the customer is going based on the pickup and drop-off provided.

Miles You Are Traveling *

Hours You Are Traveling (From Google)

Minutes You Are Traveling (From Google) *

Note: For trips with 1-20 miles, Travel Minutes are fixed and cannot be edited.

Service Area Options

Standard Service Area Out of Service Area

Out of Service Area Miles *

Extra Stops

Note: Each extra stop will incur an additional charge of $10.00.

Policy Agreement

Refund Policy: No refunds are provided for services unless United Taxi Services cannot provide the service. All payments must be made by card, and invoices will be sent via text or email.

Your Full Name *

Date of Agreement *

Summary of Information

Your entered details will appear here...

Financial Summary

Your charges will appear here...

Driver's Summary

Your driver's summary will appear here...

Discount / After Pay Options

The total is over $50. You can optionally offer a 10% discount or set up After Pay.

No discount 10% Discount

Would the customer like After Pay?

No Yes

Drivers Information

Name	Email	Phone Number	Location	Notes
Rodney Downing	[email protected]	330-649-1678	Canton, Ohio	N/A
Maurice Downing	[email protected]	330-268-3209	Canton, Ohio	N/A
Michael Fluharty	[email protected]	740-227-0044	Canton, Ohio	N/A
Michael Mills	[email protected]	330-224-7313	Canton, Ohio	N/A
Alonzo Burnett	[email protected]	216-272-1190	Cleveland, Ohio	N/A
Bruce Napier	[email protected]	216-672-1145	Cleveland, Ohio	N/A

UTS Booking Form

Personal Information

First Name *

Middle Name (Optional)

Last Name *

Phone Number *

Email Address *

Date of Birth *

Who is this ride for?

This ride is for me This ride is for someone else

Rider's First Name *

Rider's Last Name *

Rider's Phone Number *

Preferred Contact Method *

Rider's Gender *

Who will be paying for the service?

I will be paying Someone else will be paying

Payee's Full Name *

Payee's Phone Number *

Payee's Email Address *

Payee - Street Address *

Payee - City *

Payee - State *

Payee - Zip Code *

Pickup and Drop-Off Information

Pickup - Street Address *

Pickup - City *

Pickup - State *

Pickup - Zip Code *

Drop-Off - Street Address *

Drop-Off - City *

Drop-Off - State *

Drop-Off - Zip Code *

Service Details

Service Type *

Add Special Instructions

Special Instructions

When would you like your ride? *

For Today *

Select Time *

Trip Type *

Return Date *

Return Time *

Is there going to be wait time? *

Wait Time (Hours)

Wait Time (Minutes)

Number of Passengers *

Notification Preference *

Please go to Google to find out how many hours and minutes it will take to get where the customer is going based on the pickup and drop-off provided.

Miles You Are Traveling *

Hours You Are Traveling (From Google)

Minutes You Are Traveling (From Google) *

Note: For trips with 1-20 miles, Travel Minutes are fixed and cannot be edited.

Service Area Options

Standard Service Area Out of Service Area

Out of Service Area Miles *

Extra Stops

Note: Each extra stop will incur an additional charge of $10.00.

Policy Agreement

Refund Policy: No refunds are provided for services unless United Taxi Services cannot provide the service. All payments must be made by card, and invoices will be sent via text or email.

Your Full Name *

Date of Agreement *

Summary of Information

Your entered details will appear here...

Financial Summary

Your charges will appear here...

Driver's Summary

Your driver's summary will appear here...

Discount / After Pay Options

The total is over $50. You can optionally offer a 10% discount or set up After Pay.

No discount 10% Discount

Would the customer like After Pay?

No Yes

UTS Booking Form

Personal Information

Who is this ride for?

Who will be paying for the service?

Pickup and Drop-Off Information

Service Details

Service Area Options

Extra Stops

Policy Agreement

Summary of Information

Financial Summary

Driver's Summary

Discount / After Pay Options

Drivers Information

UTS Booking Form

Personal Information

Who is this ride for?

Who will be paying for the service?

Pickup and Drop-Off Information

Service Details

Service Area Options

Extra Stops

Policy Agreement

Summary of Information

Financial Summary

Driver's Summary

Discount / After Pay Options

We Would Love to Have You Visit Soon!

Hours

Telephone

Email