Greeley Evans Transit: Guaranteed Ride Home Refund Request

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Commuter Information

GRH Registration Confirmation Number *

If you do not have a confirmation number, please register here. If you do not enter a valid confirmation number, your request will not be processed.

Name *

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone *

Email *

What was the location of your missed ride? *

Work

School

Employer Address *

Street Address Address Line 2 City State ZIP Code

Employer Representative Name *

First Last

Phone Number of Employer Representative or Supervisor that can verify that you were at work the day GRH was used. *

Employer Representative Email *

School Address *

Street Address Address Line 2 City State ZIP Code

Representative Name - someone that can verify that you were at school the day of GRH used. *

First Last

Representative Phone *

Representative Email *

Date Guaranteed Ride Home was Used *

How Did You Get to School or Work the day GRH was used? *

Reason for Using Guaranteed Ride Home *

Ride Share or Transportation Company Used *

Cost/Fare *

Attach receipt(s) to this form. Receipt(s) must indicate date, cost and trip information to be valid) *

Drop files here or

Max. file size: 400 MB.

By submitting this form, the participant certifies that all the information stated above is true. The GRH Program has the right to request additional documentation or information if needed. If the program administrator determines the use of GRH was invalid, reimbursement will be denied.

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