東京都港区の介護タクシー『スリーシー』

スリーシー

For reservation:070-3995-7136

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ご予約・お問い合わせ

  1. TOP
  2. Reservation and questions

Please fill in the following forms for reservation;

Name in full
Required

ex : John Smith
eMail Address
Required

ex : example@3c-3cs.com
Reservation Date
& Time
Required
Month:   Day: 
Going:   hr    min
Coming back:   hr    min
Postal Code
Required

ex : 106-0047
Address
(the building name included)
Required


Building name, room number
Telephone Number
Required

The place to be
picked up

ex : home
Destination Address
ex : ○○ hospital
Wheelchair required
or not
Required

※Please select below when the wheelchair is required.

Number of passengers
Required

※Please state how many passengers will be including yourself.

Other
※If you estimate hope, please enter here to that effect.