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1. Name of your Group:
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2. Journey details:
Start date:
End date:
Start time: (please say if AM or PM)
Finish time: (please say if AM or PM)
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3. Booker details:
Name:
Contact number:
Email address:
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4. What type of vehicles do you require?(select how many you need)
16 seater minibus (non accessible)
W/chair accessible (9 seats, includes 1 wheelchair space)
W/chair accessible (12 seats, includes 2 wheelchair spaces)
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Number of passengers (if known):
Number of wheelchair users (If known):
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5. Do you require a driver?
NO - I will use my own driver, his/her name is:
YES - I need an ECT professional Driver. State the times you wish to book the driver and minibus:
Pick up Time:
Pick up Address:
Destination:
Return Time:
Return pick up Address:
Return destination:
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Will you be providing a list of passenger addresses? (where appropriate): Yes No
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Do you require the driver to stay with you once you are dropped off? Yes No Unknown
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6. Do you require an ECT passenger assistant?: Yes No
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7. Is there any additional information you would like to provide?
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