:: YELLOW TAXI CAB ::

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We provide round trip service; include long distance travel for Medicaid approved patients.

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Taxi fees: Our Taxi Cab rates include a $3.50 pick-up fee.$2.59 per mile of travel with a $0.30 per minute waiting fee.

We also offer following flat rules for taxi fare to and from the Ft Wayne International Airport.

If there are questions on the form you can not answer, or if you need to speak to the dispatcher, please call 260-422-1010.

Name: *

House: *

Street: *

City: *

Area Code : *

Passenger

Pick-up Date

Pick-up Time:

:
(12:00 a.m. is midnight and 12:00 p.m. is noon)

Type of Vehicle:

Please provide information about where you can be reached if the driver has difficulty finding you or if there are questions about this order.

Phone Number:*

- - ext.

Alternate Phone Number:

- - ext.

email:

Would you like to receive email confirmation of this order?
Yes, please send a confirmation to the email address entered above.
No, do not send a confirmation.

How will you pay for service?

	Cash
	Credit Card (All Major Credit Cards Accepted

Bilingual Driver

Yes
No

Any other special requests?

160 characters remaining

Would you like to receive a follow up survey?
Yes
No

All vehicles are operated by independent contractor drivers.