Appointment The Basin and The Towel, LLC The Basin and The Towel, LLC Travel Booking and Services Facility / Medical Personal Name:(Required) First Last Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City State ZIP / Postal Code Appointment Date(Required) Month Day Year Appointment Time(Required) Hours : Minutes AM PM AM/PM Type of Service or Support(Required) Community Transportation (Medical or Non Medical) Non-Emergency Medical Travel RideShare Delivery Vehicle for Hire NEMT- City to City NEMT-Out of State Delivery (Food/Groceries/Meals) Courier Packages (Small to Medium) Human and Social Services Planning Human and Social Services Consultancy/Advocacy Other OtherTransportation Information: Population and Locality(Required) Entire Population Limited Population Group Rural (Specific) Urban Suburbia In-City (Specific) City to City (Specific) Rural Areas (Specific) County to County or Intra-County Inter-State (Via Approval) Rural (Specific)In-City (Specific)City to City (Specific)Rural Areas (Specific)The Type Provided(Required) Car/Sedan-Medium SUV Other OtherPlease Select transportation/travel duration(Required) 2/3 Days per week 4-7 Days per week 2 Weeks Duration 25-30 Days 6-Month Interval 12-Month Interval Daily Weekly CAPTCHA The B&T Connect Courier & Delivery Services & Support Network Small to Medium Courier Packaging and Delivery Services Name of Company/ Entity(Required) Full name Phone(Required)Email(Required) Date(Required) Month Day Year Type of Courier Packaging or Delivery(Required) Manila Envelope(s) Small Size Box(es) Medium Size Box(es) 1-5 Moving Boxes Other Type of Delivery (Pick Up & Delivery)(Required) Department Stores Local Grocery Chains African & Asian Grocery Stores Any Stores ( Specific) Other Any Store (specific)Type of Delivery (Pick Up & Delivery) pt.2(Required) Bagged Groceries Hot Food from Restaurants Cold Food/Veggies/Salad Items Left @ Family or Friends Apt./ House/Home Home Depot Lowe's Menard's Home Improvement Other Type of Delivery (Pick Up & Delivery) pt.3(Required) Cosmetic Stores Any Stores ( Specific) Mini Mart-Gas Stations Organic or Health Food Stores Special Orders: Walmart or Target Other Any Store (specific)Type of Catering Delivery(Required) Small Catering Orders Medium Catering Orders Large Catering Orders CAPTCHA Booking Write Your Feedback Now Amelie Clarcs Professional Dentist Nick Peterson Professional Dentist Olivia Johnson Professional Dentist
