Employer Registration Form
* required fields
* Employer name (company)
* Department
* Employee Transportation Coordinator
* Address (street name, e.g. 4645 Vanderbilt)
* City
* State
Please select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
* Zip code
* Email:
* Phone:
* Web site
* Guaranteed Ride Home
YES
NO
* Link to GRH on website
* Pretax Incentive
YES
NO
* Link to pretax incentive
* Lucky Bucks Program
YES
NO
* Link to lucky bucks
* Lunchtime Express
YES
NO
* Link to lunchtime express
* Participate in Transportation Events
YES
NO
Describe events and company participation
* Monthly Drawing
YES
NO
Describe incentive
* Carpool & Vanpool Subsidy
YES
NO
* Charge for parking?
YES
NO
* Preferential parking
YES
NO
* Public Transit Available
YES
NO
* Link to bus page
* Worksite conveniently located for cyclists
YES
NO
* Link to bike page
* Dedicated bikeway or bike lane to the site
YES
NO
* Uncovered bike racks
YES
NO
* Covered bike racks
YES
NO
* # of racks
* Location of racks
* Showers
YES
NO
* # of showers
* Location of showers
* Clothes Locker
YES
NO
* # of lockers
* Location of lockers
* Describe how to access lockers
Gym
YES
NO
* Login name
* Password
(4-10 characters)
* Password again
Copyright ©2010 San Luis Obispo Regional Rideshare. All rights reserved.