Form 3682: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Name of Facility' and 'Vendor No.' at the top of the form. This information identifies the service provider responsible for transportation.
Next, input the 'Date' of service. This is crucial for record-keeping and compliance.
Fill in the 'Individual Name' field to specify who is receiving transportation services.
Document the 'Time Pick Up' and 'Time Drop Off' for each individual. Ensure accuracy as this reflects service delivery times.
List all individuals being transported in the designated fields (1 through 25). Include their respective pick-up and drop-off times.
Finally, ensure that a driver’s signature is provided at the bottom of the form to certify that all information is true and correct.

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