Taxi Ticket Application

Name

Phone

Physical Address

City/Town

State/Province

ZIP/Postal Code

Physical Address

Birth Year

You are:

60 years of age or older

Younger than 60 years of age with proof of disability

In City limits

Outside of City limits

Customer cannot be trasnferred from a wheelchair into the taxi/van seat for trasnport

I certify that I am a resident of the City of Pendleton and that the information provided is correct

E-Signature

By typing your name here, you certify the information in this form is correct.

Driver's License or Disability Letter

Please provide a copy of your driver's license or disability letter
One file only.
256 MB limit.
Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 mp4 ogg wav bz2 dmg gz jar rar sit svg tar zip.

How will you receive your taxi tickets?

Pick up at Pendleton City Hall

By mail at the "mailing address" listed above

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