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Request a Ride

Need a ride? Fill out the following form to submit a request and we will work to match a driver with your need!

Need help filling out this form? Call us at 503-226-0700 or send email to ride@rideconnection.org.

Please note that most services require an advance notice.

Although we work hard to meet every customer's needs, due to limited funding and driver availabilty, we may not be able to fulfill all ride requests.

RideRequest

Required fields are marked with asterisks (*).

Customer Information

All new customers will be contacted for a new customer registration.
Are you a *

Customer Name *  
Contact Name *  
Relation to Customer *  
Phone or Email *  

Trip Details
How many people, including yourself, will be traveling? *  
  
Please select any mobility device(s) that traveler(s) will use   
  
Special Instructions
500 characters max.
  

Pick Up Location & Time
Is the date/time flexible? *

If not, please enter       
    Pick Up Date  
    Pick up time  
If so, please provide up to 3 dates and time ranges  
Pick Up Location Name  
Street Address *  
Suite/Apt/Unit #  
City *  
Zip *  
Phone Number  
Is this your home address? *

  

Drop Off Location
Drop Off Location Name  
Street Address *  
Suite/Apt/Unit #  
City *  
Zip *  
Phone Number  

Return Trip Information
Is a return trip needed? *  

If yes, please enter  
    Return Trip Date
    Return Trip Time
Return Pick up Address  


Location Name  
Street Address  
Suite/Apt/Unit #  
City  
Zip  
Phone Number  
      

Please note: A Ride Connection representative will be in contact with you once we receive your request.

503.226.0700 | info@rideconnection.org
 
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