DOTS :: Charter Request Form

Customer Information

= required information

Department/Organization:
Representative:
Complete Campus Address:
Phone:
E-mail Address:
(all responses will come to this address)
Charter Contact Person:	Name Mobile Phone
(someone who will be present on the charter)
Date Submitted:

If different from Representative

Billing Contact:
Phone:
E-mail Address:

Trip Information

Type of Bus:

COACH
Coach Bus

TRANSIT
Transit Bus

VAN

SUV
SUV

Date(s) of Trip:

Purpose of Trip:

Please describe in more detail below:

Number of passengers:

Departure Point Information:

Name/Title of Place:
Full Address:
Departure Time:

Destination Point Information:

Name/Title of Place:
Full Address:

Return Pickup Point:

Location:
Time:

Return Destination:

Full Address:
Time of final dropoff:

Special Instructions:

FRS number to be billed:

Please Note: submitting this form represents a request for an estimate for charter service. A member of the Charter Department will contact you with this information. Service will not be provided until a contract is signed.

Department of Transportation Services, Bldg #202 Regents Drive Garage, College Park, MD 20742
University of Maryland; Office Hours: 8:15 a.m. - 4:00 p.m.
Phone: 301-314-PARK (parking inquiries) or 301-314-2255 (transit inquiries). E-mail: transportation@umd.edu