Charter Customer Quote Request
Please fill in all items on form completely and accurately.
SECTION I - IMPORTANT INFORMATION
Group/Organization Name
*
Last Name
*
First Name
*
Telephone Number
*
Fax Number
*
Your Zip Code
Email Address
*
Confirm Email Address
*
Have you chartered a bus / motor coach with us before?
*
Yes
No
How many trips do you take per year?
1-5
6-10
11-20
21+
CHARTER INFORMATION:
Number of Passengers
*
Type of Group? (Church, civic, school, etc.)
What type of trip will this be?
One Way
Round Trip
Other type of trip?
Exact address of Pickup Location:
Exact address of Destination Location:
Please provide us with any important details of your itinerary:
*Including Exact Pickup Dates & Times.
Are you flexible on your times or dates?
Times
Date
Neither
Wheelchair Accessibility
Needed
Not Needed
MARKETING INFORMATION:
Would you like to receive future promotional specials?
Y
es
N
o
Would you like us to mail you our group tour brochure?
Y
es
N
o
How did you hear about us?
Existing Customer
Internet Search Engine
Internet Yellow Pages
Mailing
Email
Newspaper / Magazine
Word of Mouth
Trade Show
Employee Referral
Bus Advertising
O
ther
If you chose the "Other" in the previous question, please describe.
dstephens@goodwheels.org
