Information Form
Customer details
Name: __________________________________________________________
House address: ___________________________________________________
District: ____________________________________________
Phone: ___________________ | Home Pickup time: _____________ | Office Pickup time: ___________
Office details
Company name: __________________________________________________________
Company address: ___________________________________________________
Building name: ____________________________________________
District: ____________________________________________
Seat packages (Pooling): more than 1 person
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One time: ($26 monthly): __________________
Go & Back: ($48 monthly): __________________
Three times: ($66 monthly): __________________
Four times: ($84 monthly): __________________
Gold / Premium packages (Separate vehicle)
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One time: ($65 monthly): __________________
Go & Back: ($96 monthly): __________________
Three times: ($132 monthly): __________________
Four times: ($210 monthly): __________________
Note: There will be Monthly additional charges if your Distance exceeds 4 Kilometer
4KM to 6 KM: ($5): __________________
6KM to 8 KM: ($8): __________________
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Selected package fare will be
USD $ __________
You will pay above amount at:End of the Month: _________________________
Beginning of the Month: ____________________
Signature: _______________
Date: _______________
------------------------------------------------------------- Geeye Office----------------------------------------------------------Name: ________________________________________________________
Title: ____________________________________________
Signature: _________________________
Date: ____________________
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