Your e-mail address will never be sold or given to anyone else.

* Required information.

Commuter Information

Last Name: *

First Name: *

Home Address: *

Cross Street:

City: *

Zip Code: *

Primary Phone: *

Secondary Phone:

Fax Number:

E-Mail Address: *
 

Destination Information

Employer Name: *

Work Address: *

City: *

Zip Code: *
 

Your Preferences

1. What travel route do you prefer to commute to work? I-91 North I-91 South I-95 North I-95 South Route 10 North Route 10 South Route 1 North Route 1 South Route 15 North Route 15 South Route 34 Other
If Other:

2. How many days per week do you commute to work? 1 2 3 4 5 6 7

3. Where would you like to be contacted?
Home
Work

4. In a carpool, would you prefer to:
Drive Only
Ride Only
Share Driving

5. What time do you normally start work?
Time: *
AM
PM

6. What time do you normally leave work?
Time: *
AM
PM

7. Are your work hours flexible by:
15 minutes
30 minutes
45 minutes
60 minutes

8. Are you interested in becoming a vanpool driver?
Yes
No

9. Are you interested in joining a vanpool from your home area to your work area?
Yes
No

10. How would you like your match list sent to you?
Mail
E-mail
Fax