First and Last Name (Passenger #1) *

Ex.: Jane Doe
 
Date of Birth (Passenger #1) *

 
First and Last Name (Passenger #2, if applicable)

Ex.: Jane Doe
 
Date of Birth (Passenger #2, if applicable) *

 
Cell Phone Number (XXX) XXX-XXXX *

Please enter parent/guardian cell phone number for minor passenger(s) under 18.
 
Home Address *

Ex: 123 Home Street, Anytown, SC 12345
 
What is the date for your pick-up? *

 
Pick-up Address *

Ex: 234 Bird Lane, Anytown, SC 12345
 
Drop-off Address *

Ex: 345 Brown Road, Anytown, SC 12345
 
Once we receive your Pick-up and Drop-off locations, we will provide a quote based on the mileage per "lift" (ride/trip). Please choose an option below: *


 
Please check which day(s) of the week you are requesting Need-A-Lift services. *


 
If you selected 'Custom time' in the previous question, what is your desired pick-up time?

ex: 8:45 AM
 
If you selected 'Custom time' in the previous question, what is your desired drop-off time?

ex: 1:45 PM
 
If you have any questions completing the Need-A-Lift registration Form, please contact our office at (803) 400-2105. Thank you for choosing us for your transportation needs!

Your Need-A-Lift registration form has been successfully submitted!

A member of our team will contact you by phone in 24-48 hours to confirm your trip details and invoice for payment. Registrations received on weekends will receive a call back on Monday.

If you have any questions or need to cancel or reschedule your Lift, please call Need-A-Lift Support at (803) 400-2105.
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