SafeRide Service Reservation Request

Fill in the information below to request a reservation for a team of SafeRide America drivers to drive you and your car home for you. Please give us as much detail as possible.

No FLEX RESERVATIONS for New Years! We will either call or email you a confirmation.

If after submiting this reservation you would like to make changes to any detail please call us at 404-888-0887.

Although you must use a credit card to hold this reservation you can pay with the card or in cash without having anything billed to your card.

Name & Contact Information

CLICK HERE to make a reservation for New Years! DO NOT use this form to make a reservation for New Years

* First Name

* Last Name

* Email Address

* Phone

* Are you a member?

Yes

No

Pick-up Details

* Are we picking you up from a business or a residence?

Business

Residence

What is the name of the business, sub-division or apartment complex?

Pick-up Street Address

Address Line 2

City

State

Zip Code

Pick-up Location Phone Number (Optional)

* Number of people in your party

Reservation Type

* Select type of reservation. (Select one)

FIRM Reservation (For a set specific time)

NO FLEX RESERVATIONS FOR NEW YEARS! FLEX Reservation (This is for when you are not exactly sure when you want to be picked up. This option allows for a two hour window of time and you must call at least one hour before you want to be picked up.)

Enter FIRM Reservation Details Here

SafeRide Service Pick-up Date

If we are booked for a particular pick-up time, "Unavailable" will be next to the time...that means we are booked for that time.

Firm Pick-up Time

Enter FLEX Reservation Details Here

NO FLEX RESERVATIONS FOR NEW YEARS! SafeRide Service Pick-up Date

Earliest Pick-up Time

Latest Pick-up Time

To insure a prompt pick-up time, I acknowledge and understand that I must call 404-888-0887 at least one-hour before I want to be picked up.

Pick-up Details

* What kind of car will we be driving? Enter the make and model.

* What color is the car?

* Type of transmission

Automatic

Manual (Stick shift)

Special Instructions

Drop-off Details

Street Address

Address Line 2

* City

State

Zip Code

SafeRide Driver Request

* If you prefer to have a particular driver, enter their name here, if not enter none.

SafeRide Service Rates

THE RATE FOR ALL NEW YEARS PICK-UPS IS $20 pick-up fee plus $2.50 per mile, plus tip to the drivers

The basic rate for SafeRide Service is
$15 pick-up fee plus $2.50 per mile, plus tip to the drivers, however,
Through the end of August 2009 everyone pays only $10 Pick-up and $2.00 per mile plus tip!

If picked up from a sponsoring location or a members home
$10 pick-up fee plus $2.00 per mile, plus tip to the drivers
CLICK HERE to see a list of sponsoring locations

If you are a Project 21 Member being picked up from any location
$10 pick-up fee plus $2.00 per mile, plus tip to the drivers
CLICK HERE to learn how to become a Project 21 Member

Pick-ups from sports and concert venues such as Philips Arena, Georgia Dome, Turner Field, Hifi Buys Lakewood Ampitheater, Chastain Ampitheater, Verizon Ampitheater, The Tabernacle, Gwinnett Civic Center, Fox Theater may be subject to additional pick-up fees. Please call for a quote on pick-ups from these or similar venues.

* Choose the rate that applies to you (Rate chosen will be verified and adjusted if necessary)

$10 pick-up fee, plus $2.00 per mile, plus tip to the drivers (Non-Member/Non-Sponsoring Location)

$10 pick-up fee, plus $2.00 per mile, plus tip to the drivers(Member/Non-Sponsoring Location or Non-Member/Sponsoring Location))

Project 21 Member rate- $10 pick-up plus $2.00 per mile plus tip

Unsure? Please contact us to discuss the rate.

Credit Card Information

Name on Card

Credit Card Type

Credit Card Number

Expiration Date (mm/yy)

CSC Code

Billing address for this card

Billing Zip Code

Enter an email address here if you would like to receive an email confirmation of your transaction

* Indicates Response Required

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Light Blue	Dark Blue	Red/Burgundy
Green	Yellow/Gold	Orange
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