Order A Ride#

Order A Ride

Customer Basic Information

* Indicates required field

First Name *

Email Address *

Last Name *

Phone Number *

Secondary Number *

Trip Type *

Service Type *

Number of passengers *

Will there be any luggage if yes how many *

Upload Drivers License/ID used to verify real customers *

Max file size: 20MB

Authorized Payment Acknowledgement

Customer Bank Name *

Date *

I the customer understand that if I purchase services that there are no refunds on invoices or any appointments I may setup i have read the terms if you understand the terms and conditions please select yes or no *

Bank Phone Number *

Signature of Acknowledgement of services *

We only accept debit cards do you understand and acknowledge *

TRANSACTION A MOUNT QOUTED BY UNITED TAXI SERVICES *

Upload Head Shot helps verify real customers *

Max file size: 20MB

Service points of pick up and drop off

Pickup Address *

Line 1

Line 2

City

State

Zip Code

Country

Drop off Address *

Line 1

Line 2

City

State

Zip Code

Country

Submit

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