Reservation Form - LX Limo Service

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Your Information

To send your reservation via Fax, Please click here

First Name:	*	Last Name:	*
Street Address:	*	City:	*
State/Prov:	*	Zip/Postal:	*
Country:	*
Phone:	*
Fax:
Mobile Phone:		Your Email:	*

Pick Up Information

Use the address information listed above.

	For airport pickup click here
Street Address:	*
Address2:
City:	*
State/Providence:	*
Zip/Postal Code:	*
Date of Pickup:	*
Time of Pickup:	*
List Passengers:
Additional Information: (return, special needs, etc)

Destination

Use the address information listed above.

Destination:	*
Address:		City:	*
State/Prov:		Zip/Postal:
Number of Passengers:		Suitcases:
	*NOTE: 6 or more suitcases will require Luxury Van or Limousine.
Type of Car:	*

Credit Card Information

Please fill out the following information.
Credit Card Type	*
Credit Card Number:	*	Exp:* (mm/yy)
Name on Credit Card:	*
Card Billing Address:		City:
State/Prov:		Zip/Postal:
Card Holder's Phone:	*
Please keep this Credit Card information on file for future services.

Comments

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

I AGREE

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