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7/4/2009 3:45am

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Mainstream On-line Reservations

COTA Mainstream - SCHEDULE A TRIP

Customer Service is open until 7:00PM Monday through Friday. e-mail requests received after close of the business day will be processed the next day after 8:00AM. Reservation requests may be placed one to seven days in advance of the trip date. All e-mail requests received on weekdays will be processed. Only e-mail requests for next day bookings will be processed on the weekends. You can expect a return e-mail on your trip status from Mainstream on the day the request was submitted. If you do not receive a return e-mail, please call Customer Service at (614) 272-3033 to confirm your trip request.

Client Name:
Date of Birth:	(mm/dd/yyyy)
Date Of Trip:
Pickup Request By:
Requested Pickup/Appointment Time:	Ex. 3:00pm
Type of Service:

Pickup Location
Location Name:
Street Address:
City:
Zip Code:
Phone #:
Pickup Location Instructions:
How Many Companions:	(More than one, on space available basis.)
Personal Care Attendant (PCA)?:
Mobility Device:
Accommodations Instructions:

Drop Off Location
Location Name:
Street Address:
City:
Zip Code:
Phone #:
Comments:
E-mail Address:
(This form will be sent to your email address)
How Will You Pay?:
Same Day Return Trip?:
(Anything other than same-day return to point of origin needs to be submitted as a separate request.)
Return Request By:
Requested Pickup/No Earlier Than Time:	Ex. 3:00pm

Note: if you do not receive a confirmation e-mail message after submitting your request, please contact the Mainstream reservations office at (614) 272-3033. Thank you.

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