RequestAssistancePassengers

Axxicom Airport Caddy

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Request form for Passenger's Assistance at the Brussels Airport

E-mailadres van afzender
E-mail *


Name applicant: *
Phone number applicant: *
Address applicant: *
Postal code and city name: *
E-mail address: *
Is the applicant the same person as the passenger? *

Passenger's data
Name: *
Surname(s): *
Gender: *
Age: *
Mobile phone:
Handicap: *
Able to walk?: *
Maximum distance able to walk: *
Able to use the staircase?: *
If you cannot walk, are you able to exchange wheelchairs yourself?:
If you cannot walk, do you own a wheelchair?:
Electrical wheelchair?:
Wet cell?: *
Do you travel with oxygen?: *
Do you have other physical restrictions?:
Arrival date/time at Brussels Airport: *
Flight data:
Flight number: *
Arrives by car/taxi/train/bus:
Passenger must be picked up at: bus or trainstation, taxi duty station, level arrival or departure, parkings FP1-3/CD, or one of the posts at the airport: *
Other remarks:

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