Trip Sign Up

Trip Sign Up Form For Transportation Service

If you’d like to utilize our transportation services for your trip, please complete our form below.

Trip Sign Up Form

Would you like us to transport you for your trip? Please fill out the form below and one of our customer service representatives will contact you shortly to confirm the details of your trip.

Date Of Trip*
MM slash DD slash YYYY
Trip Location*
Name Of Trip Destination
Where Are You Going?
Time Of Trip (Start & Return Time)*
Location Of Trip*
Street Address City ZIP Code
Where Will We Pick You Up From?
Trip Departure Time*
Pickup From Address*
Street Address City ZIP Code
Number Of Passengers
Number Of Adults*
Number Of Children*
Contact Information
Contact Persons Name*
First Last
Home Phone*
Work / Cell Phone*
Email*
Payment Type:*
***Please Note*** Regardless of payment type, we require a credit card on file for incidentals, and/or damages.
- Check
- Credit Card / Debit Card
- Money Order
Credit Card Information:
Name On Card:*
First Last
Billing Address:*
Street Address City State ZIP Code
Card Type:*
- Visa
- MasterCard
- American Express
- Discover
Card Number*
Expiration Month & Year*
3 Digit Security Code*
Terms Of Service:
Permission For Service:*
By filling out this form, you are giving us, Astoria Express Transit permission and authority to transport you and your your passengers to and/or from the location you listed above. You agree and acknowledge that all payments are due IN ADVANCE AND BEFORE SERVICE IS RENDERED. You also agree Astoria Express Transit is not responsible for any lost or stolen items on one of our buses. **48 Hour Cancellation Policy** A 50% down payment is required to reserve your trip. If you need to cancel your trip, please inform us 48 Hours prior to your trip date to receive your deposit back. If cancellation is given in less than 48 hours, no refund will be given for any reason. If you fail to comply and agree to these terms of service, we cannot provide you service.
- I agree to the terms of service and release Astoria Express Transit Of Any And All Liability.
Other Notes:
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Phone
This field is for validation purposes and should be left unchanged.

Trip Sign Up Form For Transportation Service

Trip Sign Up Form

Where Are You Going?

Where Will We Pick You Up From?

Number Of Passengers

Contact Information

Credit Card Information:

Terms Of Service: