Transit Services

Paratransit Request Form

Please fill out the form completely in order to assure that we receive all of the information. If you have any questions when filling this form out, please give us a call at 419-530-1026.

* these fields must be completed
Name and Contact Information

Pickup Request 1

Click Here if you have a Second Pickup

Click Here if you have a Third Pickup

Click Here if you have a Forth Pickup

If you have more than four requests to make. You will need to submit the first four and then fill out another form to requests four more. You may submit as many as you need to but only 4 a form.

Submitting a Pickup Request form doesn't guarantee a pickup. If your rides are accepted we will send you a follow up email confirming them or rejecting them.