Airport Secure Reservation Form

*** Click Here For Other Services On-line Reservation ***

We go anywhere, anytime,

24 hours per day,

7 days per week,

365 days per year!

Reservation Request (please fill in all information as applicable)
(* - required fields)

Personal Information

   *Last Name:    *First Name:

   Company:    *E-mail:

   Address:    City/State/Zip:

   Phone:    Cell Phone:


Airport Round Trip One Way Hourly Point To Point Wedding


Vehicle Type Preferred:    Passengers:    Pieces of Luggage:


   Trip Date:

/

   Pick-up Time:

:


   Pick-up From:
(If known, please list cross streets with each address)

   Destination:

Flight Information Airline:    Flight #:    Departing From:

   Comments/Additional Information:




   Return Date:

/

   Pick-up Time:

:


   Pick-up From:
(If known, please list cross streets with each address)

   Destination:

Flight Information Airline:    Flight #:    Departing From:

   Comments/Additional Information:




   Credit Card Information

   *Credit Card #:    *Exp. Date:

   *Name as it Appears on Card:   

   Billing Address:

I, hereby authorize M.D. Limousine Inc. to charge the above listed credit card account the amount indicated on my contract, and that I will in good faith, make good on the contracted charges.
I, the undersigned, do hereby personally guarantee payment of the full contracted amount in the event of non-payment without just cause by the above named company.
A non-refundable 30% fee will be charged for contracts cancelled without sufficient notice.


   Other payment methods accepted   Learn about payment with PayPal

   Drivers have credit card machines in all limos. We also accept cash.

When placing your reservation, please mention any quote you received from our representative either over the phone or via the internet

   We will call or e-mail you immediately to confirm receipt. Thank You!