This section contains amendments from September 28,
1998.
Appendix A to Subpart H of Part 37--Service Request Form
Form for Advance Notice Requests and Provision of Equivalent Service
1. Operator's
name__________________________________________________________
2.
Address________________________________________________________________
_________________________________________________________________________
3. Phone
number:____________________________________________________________
4. Passenger's
name:__________________________________________________________
5.
Address:_________________________________________________________________
__________________________________________________________________________
6. Phone
number:____________________________________________________________
7. Scheduled date(s) and time(s) of
trip(s):__________________________________________
__________________________________________________________________________
8. Date and time of
request:_____________________________________________________
9. Location(s) of need for accessible bus or equivalent service, as
applicable:________________
__________________________________________________________________________
10. Was accessible bus or equivalent service, as applicable, provided
for trip(s)? Yes ___ No ___
11. Was there a basis recognized by U.S. Department of transportation
regulations for not
providing an accessible bus or equivalent service, as applicable, for
the trip(s)? Yes ___ No ___
If yes,
explain________________________________________________________________
__________________________________________________________________________