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Phone: (336)-674-0591 / Fax: (336)-674-0591
NAME:____________________________________
DATE:________________
ADDRESS:_________________________________
PHONE:___________________________________
WORK:_______________
PICK UP DATE:____________________________
RATE:________________
PICK UP TIME:_____________________
UNTIL:________________ TOTAL TIME:_______________
PICK UP LOCATION:__________________
(please include a map, drawn on back or enclosed separately)
___________________________________________________
DESTINATION: (please include a map)_________________
__________________________________________________
SPECIAL INSTRUCTIONS:__________________________
__________________________________________________
METHOD OF PAYMENT:
DEPOSIT:______________ DATE:___________
CASH:______________________
CHECK:_______________________ TOTAL OF BALANCE:
MC/VISA/AM-EXPRESS:________________________________________
I understand that I am solely responsible for any damages that may
occur to the limousine that I am renting on the above date and I agree
to promptly pay for such damages.
Signature___________________________________________
DATE:_______________
Please fill out this form completely and fax to us at (336)-674-0591 |