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Transportation Provider Inventory Data Submission

I.  PROVIDER/ORGANIZATION

Provider                                 A value is required.     
Known As                              


II.  CONTACT 

Name                             Title                    
Address 1                         Address 2           
City                                County                      
State                                                       ZIP                           
Phone No.                                     Fax Number         
Alt No.                   
                             Email Address              
Website                 


III.  AGENCY

Agency Type                 
Federal Funding             
   
State Funding                
        
Local Funding                

Number of Employees    


IV.  SERVICE AVAILABILITY - CLIENT
Please mark all that apply.

  General Public               Elderly (please specify) 
                                                    Defined as:  50+, 55+, 60+, 65+
  Welfare to Work             Persons with Disabilities
                                                    Defined as: 
  Job Access   

Other Eligibility Requirements  


V.  SERVICE AVAILABILITY - TRIPS
Please mark all that apply.
     

  General                       School                Social/Recreational
  Work                           Shopping            Medical
  Other (please specify)                 

Are trips prioritized?              If yes, how? 


VI.  MODE/TYPE OF SERVICE
Please mark all that apply.

  Curb-to-Curb                  Fixed route          Subscription
  Door-to-Door                  Fixed schedule         (Pre-arranged standing order trip requests)
  Demand responsive        Paratransit           Other (please specify) 
                                                                                Ex:  Vanpool, ridesharing


VII.  SERVICE AREA
Please be specific - indicating street, city, and/or county boundaries.


VIII.  OPERATIONAL INFORMATION

Days and Hours of Operation

WEEKDAY 

 
From: 


To:

SATURDAY

 
From:   
        To:         
  

SUNDAY

 
From: 


To:
HOLIDAYS

 
From: 


To:   

Are reservations required?  (if applicable) 
Advance notice required                               If so, how much?       
Reservations Telephone                       Service Time Window 
Trip Segments              


Fare Structure

Children                                                         Defined as under: 
Adults                     
Discounts                           Seniors               Student 
Reimbursements    
Other Discounts     
Guest policy          
 


IX.  VEHICLE ACCESSIBILITY

Number of Vehicles  
Type of Vehicles      
Vehicles Accessible 


X.  ADDITIONAL COMMENTS

 

2/5/2014  05/21/2009 TMB

 CONTACT US | SITE MAP | LEGAL | SYSTEM REQUIREMENTS
 North Central Texas Council of Governments | 616 Six Flags Drive P.O. Box 5888 Arlington, TX 76005-5888
 Main Operator: (817) 640-3300 | Fax: (817) 640-7806