English to Russian Tech/Engineering General / Conversation / Greetings / Letters

Документ о предоставлении услуг перевозки для людей с ограниченными возможностями.

In order to provide service to you, we will need this information:
1. Your name, birth date, home address, telephone, cell phone and business telephone.
2. The address and telephone number for your primary pick up and drop off location here in Baltimore.
3. Emergency contact (name and telephone) in Baltimore, if possible.
4. Whether you will travel with a Personal Care Attendant (PCA), a companion, or both.
5. If you use a service animal.
6. If you use a **can, walker, crutches, wheelchair, scooter, oxygen or other mobility devices.

Спасибо.