Long Hauling Suspicion Form

1
Customer Information* This field is required.
First Name
Last Name
2
Phone Number
Area Code
Phone Number
3
* This field is required.Customer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
* This field is required.Email Address
example@example.com
5
Date of Incident* This field is required.When did the incident occur?
6
Approximate Time of Incident* This field is required.
7
Pickup Location* This field is required.Where were you picked up?
Aria
Bally's
Bellagio
Caesars Palace
Circus Circus
Cosmopolitan
Delano
Elara
Encore
Excalibur
Fashion Show Mall
Flamingo Hotel & Casino
Forum Shops at Caesars
Four Seasons
Fremont Hotel
Gold Coast
Golden Nugget
Hard Rock Hotel
Harrah's
Hooters
JW Marriott
Luxor
LV Convention Center
LV Motor Speedway
M Resort
Mandalay Bay
Mandalay Bay Event Center
Mandarin
McCarran Airport T1
McCarran Airport T3
McCarran Rent-a-car
MGM
Mirage
Monte Carlo
New York New York
Orleans Hotel
Palace Station
Palazzo
Palms Hotel & Casino
Paris
Planet Hollywood
Premium Outlets North
Premium Outlets South
Red Rock Resort
Rio Hotel & Casino
Sands Expo
SLS
South Point
Stratosphere
The Linq
Thomas & Mack
Town Square
Treasure Island
Tropicana Hotel
Trump Hotel
Tuscany
Vdara
Venetian
Westgate
Westin
World Market Center
Wynn
OTHER
8
OTHER Pickup LocationDidn't see your option on our list? Write your answer here
9
Dropoff Location* This field is required.Where were you dropped off?
Aria
Bally's
Bellagio
Caesars Palace
Circus Circus
Cosmopolitan
Delano
Elara
Encore
Excalibur
Fashion Show Mall
Flamingo Hotel & Casino
Forum Shops at Caesars
Four Seasons
Fremont Hotel
Gold Coast
Golden Nugget
Hard Rock Hotel
Harrah's
Hooters
JW Marriott
Luxor
LV Convention Center
LV Motor Speedway
M Resort
Mandalay Bay
Mandalay Bay Event Center
Mandarin
McCarran Airport T1
McCarran Airport T3
McCarran Rent-a-car
MGM
Mirage
Monte Carlo
New York New York
Orleans Hotel
Palace Station
Palazzo
Palms Hotel & Casino
Paris
Planet Hollywood
Premium Outlets North
Premium Outlets South
Red Rock Resort
Rio Hotel & Casino
Sands Expo
SLS
South Point
Stratosphere
The Linq
Thomas & Mack
Town Square
Treasure Island
Tropicana Hotel
Trump Hotel
Tuscany
Vdara
Venetian
Westgate
Westin
World Market Center
Wynn
OTHER
10
OTHER Dropoff LocationDidn't see your option on our list? Write your answer here
11
Amount Charged* This field is required.How much were you charged?
Ex: $12.34
12
Payment Method* This field is required.How did you pay for your ride?
Cash
Credit Card
13
Last 4 Digits of Credit Card UsedPlease enter the last 4 digits of the card you used to pay for your ride.
14
Cab NumberEach taxicab has an identifying number
Ex: 6702
15
Description of Incident* This field is required.What happened on your ride to suspect long hauling?
Please include a description of the taxicab, drivers name and Taxicab Authority Permit number if you have it.
16
* This field is required.
Should be Empty: