Prairie Hills Transit

REQUEST - A - RIDE

Request-A-Ride

Ride Request Form

Need a ride? Fill out the following form.
Please note:

Prairie Hills Transit does not provide same-day service.
If you are booking more than one round-trip ride for one day, more than one request must be submitted.
All ride requests require a 24-hour business day’s advance notice. Requests will be read Monday-Friday 7am – 5pm.

Need help filling out this form? Call us at 605-642-6668 or send email to dispatch@prairiehillstransit.com
Required fields are marked with asterisks (*).

Local Trips
- In town ONLY for public,
seniors, and assisted
living residents.
I-90 Commuter Route
- Two morning and two afternoon/evening
routes from Spearfish, Whitewood, Sturgis,
Blackhawk and Rapid City. Two morning
and two afternoon/evening routes from
Rapid City, Blackhawk, Sturgis, Whitewood,
and Spearfish.
City to City Trip
- Going to any town outside the
community you live in on the
designated schedules set in your
community for medical trips
and/or shopping.
Special Events
- 2012 RALLY DAILY SHUTTLE AUGUST 6TH - 10TH.
Special event that Prairie Hills
Transit will shuttle passengers

Customer Information
All new customers will be contacted for a new customer registration.

Are you a *

New Customer
Returning Customer Please make a selection.

Customer Name *

A value is required.

Home Zip Code *

A value is required.Invalid format.

Relation to Customer *

Please select an item.

Phone *

A value is required.

Email (optional)

Pick Up Location & Time

Pickup times for in-town service are 30 minutes before an appointment.
Pickup times will be 45 minutes if assistance is needed or outside city limits.

Pick Up Date

Select Date

Appointment time

Pick Up Location Name *

A value is required.

Street Address *

A value is required.

Suite/Apt/Unit #

City *

A value is required.

Zip *

A value is required.Invalid format.

Phone Number

Is this your home address? *

Yes No
Please make a selection

Is this an Assisted Living location?

Yes No
Please make a selection.

Ambulatory Non-Ambulatory
Please make a selection.

Additional information that may be needed, for example, certain door at either pick-up and/or drop off location.

Drop Off Location

Drop Off Location Name *

A value is required.

Street Address *

A value is required.

Suite/Apt/Unit #

City *

A value is required.

Zip *

A value is required.Invalid format.

Phone Number

Return Trip Information

Is a return trip needed? *

Yes No
Please make a selection.

If yes, please enter

Return Trip Date*

Select Date

Return Trip Time*

Additional information that may be needed, for example, certain door at drop off location.

Return Pick up Address

Same as drop off

Different than drop off

Location Name

Street Address

Suite/Apt/Unit #

City

Zip

Phone Number

Trip Details

Please select any mobility device(s) that traveler(s) will use

Service Animal	Car Seat
Scooter	Wheelchair
Wheelchair - Can Transfer	Wheelchair - Oversized
Wheelchair - Electric	Unknown/Other

Escort (a person can ride with the customer for assistance only – no charge)

Special Instructions
500 characters max.

Billing Information

First Name:

A value is required.

Last Name:

A value is required.

Address:

A value is required.

City:

A value is required.

State:

Please select an item.

Zip:

A value is required.Invalid format.

Phone:

A value is required.

Email:

A value is required.Invalid format.

Quantity (1 ticket = one-way trip) :
Buy 10 Trips and get the 11th for FREE!

Interstate 90 Commutter routes
(Monday through Friday)

No reservations are needed for the listed pick-up and drop-off locations. (Alternate pickup locations can be made by calling one business day in advance. Sites must be easily accessible from I-90)
Riders must be ready to board when the bus arrives at the stop (see arrival/pickup times).
Children under 12 must be accompanied by an adult.

Cost to ride (one-way):

Spearfish - Rapid City	$10.00
Spearfish - Sturgis	$5.00
Sturgis - Rapid City	$6.00
Spearfish - Whitewood	$5.00
Whitewood - Sturgis	$3.00

Multi-ride Discounts
	10-ride pass	20-ride	40-ride
Rapid City - Spearfish	$80.00	$160.00	$320.00
Rapid City - Sturgis	$48.00	$96.00	$192.00
Sturgis - Spearfish	$40.00	$80.00	$160.00
Spearfish - Whitewood	$40.00	$80.00	$160.00
Whitewood - Sturgis	$24.00	$48.00	$96.00

Customer Information
All new customers will be contacted for a new customer registration.

Are you a *

New Customer
Returning Customer Please make a selection.

Customer Name *

A value is required.

Home Zip Code *

A value is required.Invalid format.

Relation to Customer *

Please select an item.

Phone *

A value is required.

Email (optional)

Pick Up And Drop Off Locations

Pick Up Date

Select Date

Pick Up Location: Bus 1

Drop Off Location: Bus 1

Pick Up Location: Bus 2

Drop Off Location: Bus 2

Trip Details

Please select any mobility device(s) that traveler(s) will use

Service Animal	Car Seat
Scooter	Wheelchair
Wheelchair - Can Transfer	Wheelchair - Oversized
Wheelchair - Electric	Unknown/Other

Escort (a person can ride with the customer for assistance only – no charge)

Special Instructions
500 characters max.

Billing Information

First Name:

A value is required.

Last Name:

A value is required.

Address:

A value is required.

City:

A value is required.

State:

Please select an item.

Zip:

A value is required.Invalid format.

Phone:

A value is required.

Email:

A value is required.Invalid format.

Quantity:
Buy 10 Get 1 Free.

Fares apply to scheduled days ONLY. Northern Hills schedule is as follows:

** IMPORTANT **

Medical appointment time must be between 10am - 2pm. Call 24 hours in advance

Medical Trips to Rapid City
Monday - Wednesday - Friday

Deadwood /Lead /Central City to Spearfish
Thursday

Whitewood to any Northern Hills city (except Rapid City)
Thursday

Newell/Vale/Nisland to any Northern Hills city (except Rapid City)
Tuesday & Thursday

Edgemont / Hot Springs to Rapid City
1st & 3rd Friday

Edgemont to Hot Springs
1st & 3rd Tuesday

Custer To Rapid City
1st & 3rd Thursday

Customer Information
All new customers will be contacted for a new customer registration.

Are you a *

New Customer
Returning Customer Please make a selection.

Customer Name *

A value is required.

Home Zip Code *

A value is required.Invalid format.

Relation to Customer *

Please select an item.

Phone *

A value is required.

Email (optional)

Pick Up Location & Time

Pickup times for in-town service are 30 minutes before an appointment.
Pickup times will be 45 minutes if assistance is needed or outside city limits.

Pick Up Date

Select Date

Appointment time

Pick Up Location Name *

A value is required.

Street Address *

A value is required.

Suite/Apt/Unit #

City *

Zip *

A value is required.Invalid format.

Phone Number

Is this your home address? *

Yes No
Please make a selection

Is this an Assisted Living location?

Yes Nolease make a selectioPlease make a selection.

Additional information that may be needed, for example, certain door at either pick-up and/or drop off location.

Drop Off Location

Drop Off Location Name *

A value is required.

Street Address *

A value is required.

Suite/Apt/Unit #

City *

Please select an item.

Zip *

A value is required.Invalid format.

Phone Number

Return Trip Information

Is a return trip needed? *

Yes No
Please make a selection.

If yes, please enter

Return Trip Date*

Select Date

Return Trip Time*

Additional information that may be needed, for example, certain door at drop off location.

Return Pick up Address

Same as drop off

Different than drop off

Location Name

Street Address

Suite/Apt/Unit #

City

Please select an item.

Zip

Phone Number

Trip Details

Please select any mobility device(s) that traveler(s) will use

Service Animal	Car Seat
Scooter	Wheelchair
Wheelchair - Can Transfer	Wheelchair - Oversized
Wheelchair - Electric	Unknown/Other

Escort (a person can ride with the customer for assistance only – no charge)

Special Instructions
500 characters max.

Billing Information

First Name:

A value is required.

Last Name:

A value is required.

Address:

A value is required.

City:

A value is required.

State:

Please select an item.

Zip:

A value is required.Invalid format.

Phone:

A value is required.

Email:

A value is required.Invalid format.

Quantity:

First Name
Last Name
Date of Birth
Phone Number(s)	/
E-mail Address
How did you hear about the shuttles?

Billing Information
First Name:	A value is required.
Last Name:	A value is required.
Address:	A value is required.
City:	A value is required.
State:	Please select an item.
Zip:	A value is required.Invalid format.
Phone:	A value is required.
Email:	A value is required.Invalid format.
Quantity:	@ $20.00 each person

This transit agency is committed to providing non-discriminatory service.
To request more information or to file a discrimination complaint, contact this transit agency or the South Dakota Department of Transportation at (605) 773-3574.