Contact Information

Name:

Address:

City: Zip: County:

Phone: E-mail:

Best Time To Contact: AM PM

How did you hear about DDS Transportation Cards?

Representative: Other Gordon Johnson Diane Reico Robert Gemmell Lily Abel If "other" describe here:

Donation Information

Check or Money Order $ Payable To: Designated Driving Services / Memo: Transportation Card

Note: If any DDS drivers feel that they are in harms way at anytime, we will deactivate your Contract and Transportation Cards Immediately!