Please fill out this form on line, then click the "PRINT" button below. Fax this form along with the front and back copy of your credit card to: 1-888-LIMO949.

Your Information
First Name: Last Name:
Street Address: City:
State: Zip:
Country:    
Phone:    
Mobile Phone: Your Email:

Pick-Up Information
Street Address or Airport Name:    
Address2 or Airline Name:    
City or Arriving From:    
State/Providence or Flight No.:    
Zip/Postal Code or Arrival Time: (example: 16:30)    

Destination
Destination: Other:
Address: City:
Number of Passengers: Suitcases:
  *NOTE: 6 or more suitcases will require Luxury Van or Limousine.
Type of Car:
Date of Pickup: (ex: Jan.21.2003 to insure correct Date)
Time of Pickup:    

Credit Card Information
Card to Charge   Credit Card Issuer
Credit Card Type    
Credit Card Number: Exp Date:  (mm/yy)
Name on Credit Card:    
Card Billing Address: City:
State: Zip:
Card Holder's Phone:    
Additional Information:
(return, special needs, etc)
By signing this form you agree that (1) you are the credit card holder and (2) that you are requesting the services listed above and (3) that you are authorizing this card to be used for the requested services.

Cardholder's Signature: _________________________________________ Date: ___________


Fax the front and back copy of your credit card to: 1-888-LIMO949.