LANGS BUS LINES Service Request Form

If you prefer to print out a blank form open or download our pdf form available here.

* Contact Name:
* Preferred Phone Number: (Include Area Code)	Extension:	Preferred Time: Days Evenings Either
Alternate Phone Number: (Include Area Code)	Extension:	Alternate Time: Days Evenings Either
* Email Address:

Organization Details

School / Group / Organization Name:
Address:
City:
Province:	Postal Code:
Name of Bus Supervisor:

Trip Details:

Passenger Details:

Number of passengers 11 years and older? (Not requiring wheelchair access)
Number of passengers 10 years and younger? (Not requiring wheelchair access)
Number of passengers requiring wheelchair access?

Other comments / other destinations / details:

LANGS