SafeRide Delivery/Errand Request Form

Complete and submit the delivery/errand request form below. Errands and deliveries are done 100% for free for anyone in need. If you want to pay for your delivery or errand you can make a donation to SafeRide America or tip your volunteer delivery driver by clicking here

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

When do you want us to run the errand? *

ASAP/Anytime

Morning

Afternoon

Evening

List each place you would like for us to go. Please include the address if known.

Example: Walmart 123 Main Street, Kroger 987 Elm Street, Food Pantry 567 Dogwood Lane

List the items you would like us to pick up here

List any special instructions here

What form of payment will you use to pay for items picked up? *

Errands and deliveries are done for free. You can donate to SafeRide America or tip your delivery driver by clicking here

Terms and Conditions *

You consent to receive communications from us by phone or electronically. We will communicate with you by e-mail, text message or phone. SafeRide will not share or sell your information with anyone.

I understand that SafeRide volunteers will not pick up alcohol, tobacco or prescriptions for narcotics.