Transportation Proxy Form
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If someone other than the consumer will be scheduling trips or placing an order, a Proxy Form authorizing this representative must be completed. Separate forms must be completed for each authorized representative.
If you would prefer to print and mail this form, click here for the Proxy Form PDF.
CICOA's Way2Go Transportation service will cease operations on May 29, 2026. Unfortunately, we are no longer accepting applications for new riders. Please check our Alternate Transportation Guide or call us at 317-803-6131 for other local transportation options.