WholeRoute Business Information Form

Thank you for your order! You'll need about 15 minutes to complete this form, which will give us everything we need to start development. If you have any questions, call us at

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Let's start with your basic business info

The information here is what we'll add onto your website.

Please list up to 3 preferred website URLS, such as "BusinessName.com". We will attempt to secure your first preference, but it it’s already taken, we’ll attempt preference 2 and so on.

What are your Operational Hours?

We'll add hours of operation onto your website, as well as program them into your trip request form (if purchased) for any after hours rates.

Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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Accepted Payment Methods?

The information here is what we'll add onto your website.

Medicaid / Brokers
Private Insurance
Medicare
Visa
Mastercard
Amex
PayPal
Cash
CashApp
Venmo
ApplePay
GooglePay
Workers Compensation

Style Preferences

Fill out this section to the best of your ability. If you don't have anything for a field, don't worry - we're on it!

Layout Preference

We want to design according to what looks best to you.

Select up to 3 layouts that you like the most by clicking on the green checkmarks.

Preview each by clicking on the business name, or click on the 'open in new window' icon to the right of each URL to view the full version of the website.

Website Color Theme
Your Company Logo
Logo/References

Vehicles and Images

Let's grab information regarding your trip types so we can add relevant content to your website

Ambulatory (sedan/van)
Wheelchair
Gurney/Stretcher
Shuttle
School Bus
Luxury Sedan
Luxury SUV
Limousine
Helicopter
I want to Upload Images Now
I will Send you Images Soon
I want You to Provide Images
Upload Image(s)
When providing images please make sure you follow these guidelines:

Make sure your pictures are taken in landscape view (your phone turned to the side) , step about 20 feet from your vehicle, preferrablly in front of a health local health center with the name of the business clearly visible. Make sure that the vehicle is centered in the image so if we need to edit it, we will be able to do so.

I want to Upload Images Now
I will Send you Images Soon
I want You to Provide Images
Upload Image(s)
When providing images please make sure you follow these guidelines:

Make sure your pictures are taken in landscape view (your phone turned to the side) , step about 20 feet from your vehicle, preferrablly in front of a health local health center with the name of the business clearly visible. Make sure that the vehicle is centered in the image so if we need to edit it, we will be able to do so.

I want to Upload Images Now
I will Send you Images Soon
I want You to Provide Images
Upload Image(s)
When providing images please make sure you follow these guidelines:

Make sure your pictures are taken in landscape view (your phone turned to the side) , step about 20 feet from your vehicle, preferrablly in front of a health local health center with the name of the business clearly visible. Make sure that the vehicle is centered in the image so if we need to edit it, we will be able to do so.

I want to Upload Images Now
I will Send you Images Soon
I want You to Provide Images
Upload Image(s)
When providing images please make sure you follow these guidelines:

Make sure your pictures are taken in landscape view (your phone turned to the side) , step about 20 feet from your vehicle, preferrablly in front of a health local health center with the name of the business clearly visible. Make sure that the vehicle is centered in the image so if we need to edit it, we will be able to do so.

I want to Upload Images Now
I will Send you Images Soon
I want You to Provide Images
Upload Image(s)
When providing images please make sure you follow these guidelines:

Make sure your pictures are taken in landscape view (your phone turned to the side) , step about 20 feet from your vehicle, preferrablly in front of a health local health center with the name of the business clearly visible. Make sure that the vehicle is centered in the image so if we need to edit it, we will be able to do so.

I want to Upload Images Now
I will Send you Images Soon
I want You to Provide Images
Upload Image(s)
When providing images please make sure you follow these guidelines:

Make sure your pictures are taken in landscape view (your phone turned to the side) , step about 20 feet from your vehicle, preferrablly in front of a health local health center with the name of the business clearly visible. Make sure that the vehicle is centered in the image so if we need to edit it, we will be able to do so.

I want to Upload Images Now
I will Send you Images Soon
I want You to Provide Images
Upload Image(s)
When providing images please make sure you follow these guidelines:

Make sure your pictures are taken in landscape view (your phone turned to the side) , step about 20 feet from your vehicle, preferrablly in front of a health local health center with the name of the business clearly visible. Make sure that the vehicle is centered in the image so if we need to edit it, we will be able to do so.

I want to Upload Images Now
I will Send you Images Soon
I want You to Provide Images
Upload Image(s)
When providing images please make sure you follow these guidelines:

Make sure your pictures are taken in landscape view (your phone turned to the side) , step about 20 feet from your vehicle, preferrablly in front of a health local health center with the name of the business clearly visible. Make sure that the vehicle is centered in the image so if we need to edit it, we will be able to do so.

I want to Upload Images Now
I will Send you Images Soon
I want You to Provide Images
Upload Image(s)
When providing images please make sure you follow these guidelines:

Make sure your pictures are taken in landscape view (your phone turned to the side) , step about 20 feet from your vehicle, preferrablly in front of a health local health center with the name of the business clearly visible. Make sure that the vehicle is centered in the image so if we need to edit it, we will be able to do so.

Company Services & Features

Non-Emergency Medical Transportation
Private Transportation
Emergency Transportation
Hourly Driver Companion
Senior Transportation
Other
Health & Hygeine
Safety
Driver Quality
Vehicle/Fleet Quality
Use of Technology
Family/Locally Owned
Years of Experience
Related Experience
Affordable Rates
Large Coverage Area
Service Quality
Other

Company Story

This section will help us create a compelling story about your company.

What is your mission statement?
What is your vision statement?
How many years of combined transportation experience does your team have?
Any relevant experience in related fields?
If someone were to ask you why you're a top provider, what would your answer be?
Do you have a story about how or why you began your company? Answer here if you'd like to share it!

NEXT STEPS

Setup options

I’ll do it myself
I want you to do it for me

You'll receive PDF step-by-step instructional guides to obtain these APIs after submission of this form. Each one will take approximately 15 minutes each to complete.

For a one-time $50 API setup fee, one of our specialists can obtain your APIs for you.
I’ll do it myself
I want you to do it for me

Email us at jr@wholeroute.com and include your base rates, mileage rates, wait time rates, surcharge rates and any other rates such as additional passenger rates for each trip type (ambulatory, wheelchair, stretcher, etc)

For a one-time $50 fee, one of our specialists will conduct local market research as well as ‘secret shop’ the competitors in your city in order to ensure your rate structure is as competitive as possible. We’ll generate a rate structure which will include base rates, mileage rates, wait time rates, and surcharge rates and send it over to you for review.