"Narita Airport Care Taxi Station" : Request for booking

Fill out the entry form and click the "Next" please.

[1] Firm name of applicant
[2] Applicant's name *Required.
[3] Applicant's telephone
[4] E-Mail *Required.
[5] Name of Weelchair user
[6] Equipment selection *Required.
[7] Weight of your electric wheelchair kg :Electric wheelchair user only
[8] Overall maximum width of your wheelchair cm
PLS refer to this picture. This case, overall maximaum width is 69cm.(between handrims)
[9] Overall height above floor including wheelchair user cm
PLS refer to this picture. This case, overall maximaum width is 129cm.
[10] Total number of the passenger on board (including wheelchair user) person *Required.
[11] Baggage size and quantity
[12] Contact address (cell phone) at Narita airport
[13] One way/Round trip One way  Round trip *Required.
[14] Arriival date (Japan time) at Narita airport *Required.
[15] Airline company *Required.
[16] Flight number *Required.
[17] Arrival time
[18] Terminal number of Narita airport
[19] Departure date (Japan time) at Narita airport :Round trip customer only
[20] Flight number of return flight :Round trip customer only
[21] Departure time of return flight :Round trip customer only
[22] Destination (Hotel name or etc)
*Required.
[23] Note

 

Thank you for your cooperation !