LX Limo Service Reservation Request

Your Information
First Name: * Last Name: *
Street Address: *
 City: *
State: * Zip: *
Country: *    
Phone: *    
Fax:  
Mobile Phone: Email: *
Pick Up Information
Use the address information listed above.

Street Address or Airport Name: *
Address2 or Airline Name: *
required for airline name only
City or Arriving From: *
State/Providence or Flight No.: *
Zip/Postal Code or Arrival Time: * (example: 16:30)
List Passengers:
Destination Use the address information listed above.

Destination: *
Other:   
Address: City:
State: Zip Code:
Number of Passengers: * Suitcases: *
  *NOTE: 6 or more suitcases will require Luxury Van or Limousine.
Type of Car: *
Date of Pickup: *    
Time of Pickup: *    
   
Credit Card Information

Please use the Credit Card information that you have on file for this service.

Please fill out the following information.
Credit Card Type *    
Credit Card Number: * Exp: *  (mm/yy)
Name on Credit Card: *    
Card Billing Address: City:
State: Zip:
Card Holder's Phone: *    
Additional Information:
(return, special needs, etc)

Please keep this Credit Card information on file for future services.
Comments




Fax the front and back copy of your credit card to: 1-425-391-3203.

By submitting this form you agree with all terms and conditions, of LX Limo Service, that you are requesting the services listed above and you are authorizing this card to be charged for the requested services.

I AGREE