Emergency Ride Home Form

This form is provided for commuters who are submitting a reimbursement request for use of the Emergency Ride Home Program. This program is for *unplanned* personal emergencies such as illness, family crisis, and rideshare cancellation; it does not cover overtime, errands, medical appointments, on-the-job injury, business travel, or natural disasters. Please read the rules for eligibility at http://www.trafficsolutions.org/ERH before continuing.

* 1. Please provide your contact information. Your address will be used for mailing your reimbursement check.

* 2. Date of Your Emergency Ride Home

* 3. Time of Your Emergency Ride Home

* 5. Please provide the contact information for your supervisor such that we may confirm use of sustainable transportation to get to work.

* 8. Company Name

* 9. Cost Incurred (Any rental car charges incurred AFTER 24 hours will not be reimbursed.)

Email a copy of your receipt to Traffic Solutions at info@trafficsolutions.org, along with your contact information. If you prefer to mail a hard copy, please send it to Traffic Solutions at 260 N. San Antonio Rd., Suite B, Santa Barbara CA 93110. Call (805) 963-SAVE if you have questions.

* 10. I certify that the above described Emergency Ride Home was required for an unplanned personal emergency and meets all of the requirements of the Emergency Ride Home Program as detailed at http://www.trafficsolutions.org/ERH.