RGRTA - - Cancellation Form

Lift Line

* Name:

Email Address:

* Phone Number:

(Example: 5852225555 Do not insert dashes)

* 1. What part of your trip do you wish to cancel (please check one of the following):
(Each Trip you cancel will require completing a separate form.)

One-way trip (or, one part of a reservation only)

Round trip (both parts of reservation)

(Multiple destination trips must be cancelled individually by completing seperate One-way trip cancellation forms.)

* 2. Date of trip you wish to cancel (Please enter numbers only):


	Month	Day	Year
Example:	(08)	(16)	(2004)

* 3. Time of trip you wish to cancel (Please enter below):


	Time	AM/PM
Example:	(4:20)	(PM)

* 4. Origin Location (place you were supposed to be picked-up):

Example: 1327 East Main St., Rochester

* 5. Destination Address (Place you were traveling to):

Example: 500 South Ave, Rochester or Marketplace Mall

* 6. Reason for canceling trip:

* In Order for us to process this trip cancellation, you must read and accept the following conditions:

Any cancellation made after 5:00 PM the day before a trip is considered a late cancellation and will result in a violation. Ten or more violations within a six month time frame could result in a two-week suspension of your Paratransit service.
Unless you receive a return e-mail receipt from Lift Line, your email cancellation may not have transmitted properly and will require a follow up phone call from you.
You are responsible to check the correct box depending on whether you wish to cancel your one-way trip or your round trip. If your intent was to cancel your round trip and the one-way box is checked, you will be considered a no-show for the remaining ride which will result in a customer no-show violation. Once trip(s) are canceled, they cannot be reinstated.
Call Scheduling at 224-8330 to cancel any subscription trips more than three days in the future or to request a hold in your subscription service.

Accept Conditions

Decline Conditions

Rochester Genesee Regional Transportation Authority - 1372 East Main St. - Rochester, NY 14609 - P: 585-654-0200