Department of Transportation Services - University of Maryland

REQUEST A CHARTER

Important Fuel Surcharge Information
Due to the instability of fluctuating fuel prices, a 5% fuel surcharge will apply for the dates of service if diesel gas prices reach $4.25 per gallon based on the weekly average Central Atlantic region diesel fuel price as posted on the Energy Information website at http://tonto.eia.doe.gov/oog/info/wohdp/diesel.asp. Thereafter, for each $0.10 increase in diesel fuel, an additional 2% fuel surcharge will apply.

To ensure the best quality service, it is best to finalize your arrangements
before submitting a request. This can be done by:

Determining the number of passengers attending the function
Knowing the addresses and phone numbers of all the destinations
Giving any special information at the time the reservation is made
Planning ahead and reserving early
Confirming your reservation at least one week in advance

Please Note:

This is only a request for charter service. Confirmation must be received from
the charter manager via contract estimate before service is given.

Customer Information

Department/Organization:

Representative:

Address:

Phone:

Fax:

E-mail Address:

Date Submitted:

*If different from representative

Billing Contact:

Phone:

Fax:

Trip Information

*Please be sure to include am/pm when specifying time

Type of Bus:

COACH

TRANSIT

VAN

Date(s) of Trip:

Purpose of Trip:
Please describe in more detail below:

Number of passengers:

Address of Pick Up Point:

Time of pickup:

Address of Destination:

Address of Return Pickup Point:

Time of return pickup:

Address of Return Destination:

Time of final dropoff:

Special Instructions:

FRS number to be billed:

*Please Note: This is only a request for charter service. Confirmation must be received from the charter manager via contract estimate before service is given.