Provider Sign-up General Provider Information Transit Provider Name: Counties you serve (check all that apply): Ottawa/Allegan Kent Muskegon Who you serve (check all that apply): Seniors Medical Youth Work Disabilities Out of Area General Public Social Services Provider Logo: Recommended max width: 300px; White background preferred; 2MB limit Physical Address: Website Address: Phone Number: General Email: Provider Direct Contact Information Contact Person: Contact Phone: Contact Email: Provider Service Details Description of Services: (eg; door-to-door service, demand response, fixed route, etc. No advertising) Wheelchair Lift: (check for yes) Lift Capacity: please fill out if answered yes above Days & Hours of Operation: Geographic Area Served: Fees/Fares: Notice needed for ride: Eligibility: Proof of Eligibility Required: Information will be reviewed by Lakeshore Ride Link before posting to website.
