Accessible Vehicle Services Inc.

Online Booking Form

Please complete the online booking form at least 12 hours before the pickup time for an excellent service.

If you have any questions, please contact us by calling any of the phone numbers on the contact page.

	First Name
	Last Name
	Home Phone
	Cell Phone
	Email address
	Pickup Address
	Pickup Buzzer Code
	Pickup Suite #
	Pickup Date
	Pickup Time
	Destination Address
	Destination Suite # (if assistance is requires)
	Type of Wheelchair
	Number of Wheelchairs Travelling
	Number of Passengers Accompanying (without wheelchair)
	Contact Name
	Contact Number
	Any Additional Comments (optional)