New York Limousine Service - Reservation Fax Form

Please fill out this New York limousine service form on line, then click the "PRINT" button below.
Call us before you Fax this form to our office

This form is arranged for New York airport service.

For any other New York limousine service, please fill in your special request in the comment box below

Passenger First Name:	Last Name:
Street Address:	City:
State:	Zip:
Country:
Phone:	Mobile Phone:
Your Email:	NOTE: CONFIRMATION SENT TO THIS EMAIL

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

Destination:	Other:
No. Passengers:	Handbags: Suitcase: NOTE: OVER 8 SUITCASES WILL REQUIRE THE LUXURY VAN.
Type of Car:
Date of Pickup:
Time of Pickup:

Credit Card Type:
Credit Card Number:	Exp Date: (mm/yy)
Name on Card:
Card Billing Address:	City:
State:	Zip:
Card Holder Phone:

Please type-in any special comments or limo service instructions here!Or for othe than New York airport service.

By signing this limo service 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 New York limousine service requested.

Cardholder's Signature: _________________________________ Date: ___________