Bus Service Comment Form

(Items preceded by an asterisk * are required fields)

Salutation
* First Name	* Last Name
Street Address
City	State	Zip -
* Email Address
* Daytime Phone (w/ area code)	Alternate Phone (w/ area code)

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Select one of the following:

Select one of the following comment categories

	Proposed Fare Increase
	Commendations about services or staff
	Bus Services. Select this if your input is about:
	Operations: bus ran late, early, never showed, passed-up stop, or didn't follow route Scheduling: overloaded, missed connections, service cut Conduct: driving habits, accident, injury, or discourtesy Regulation Enforcement: smoking, drinking, or eating Services for Persons with Disabilities: Priority seating, lift operation, clamps, wheelchair access Policies: fares, transfers, or ideas for new service Information Staff Conduct: misinformation, discourtesy Amenities: lighting, seats, type of bus
	Bus Maintenance:
	Defects in A/C or heating; bus cleanliness or "smoking" bus
	Facility Maintenance:
	San Rafael Transit Center, bus stops or shelters.
	Administration:
	Lost property, customer service

Details (if applicable)

Incident Date / /		Time of Incident : am pm
Route Number		Bus Number
Your Pickup Location		Your Destination

* Comments / Description of Incident
Description of Driver or staff person (if needed)

Bus Service Comment Form

* Comments / Description of Incident

Description of Driver or staff person (if needed)