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Form for the PASSENGER who is looking for a driver to drive him/her to his/her place of destination

Information concerning the journey
I want to go from:*
To:*
Seats in the car:
Date: :
Back: :
Note:
>
Surname:*
First name:
Street and no:
Town:
Zip code:
Telephone:*
Fax:
E-Mail:*
Note: