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1. Company Name*

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2. Submitter Name* 

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3. Submitter Email*

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4. Submitter Phone*

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5. Business Address*

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6. Are you requesting for one designated pickup or multiple?

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7. Provide brief description of the issue you are having with your office location.*

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8. If the issue is not related to a driver arriving at the right location/pin of your address, please describe the issue here. *

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How To: accurately find the lat & long of the address, type in the address in Google Maps > right click the red pin > click on the lat & long numbers to copy > paste below

How To: accurately find the lat & long of the address, type in the address in Google Maps > right click the red pin > click on the lat & long numbers to copy > paste below

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9. Enter the latitude and longitude of your preferred entrance/pick up point.*

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10. Upload the smart pickup boundary for the pick up location*

PDF, PNG, JPG, JPEG file types only.
Choose File

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Example image of map showing where old (wrong) pickups were going and star indicates where the (correct) pickup should be

Example image of map showing where old (wrong) pickups were going and star indicates where the (correct) pickup should be

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11. Desired name of pick up location. This is what you will see in the Uber Health Dashboard.*

 
100% of survey complete.

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