Other Services Secure Reservation Form

*** Click Here For Airport On-line Reservation ***

   We go anywhere, anytime,

24 hours per day,

7 days per week,

365 days per year!


   Please Fill Out Carefully the Following Form

   Name:    E-mail:
   Passenger:

   Luggage:

   Pick up Date:

/

   Time:

:

   Location:    Vehicle Type:

   For a round trip reservation please select:    Address:
   Depart. Date:

/

   Depart. Time:

:

   City:    Zip Code:
(please fill up a zip code - use: #12345)
    Pick Up Information:

    Please specify address and nearest cross street and phone # at pick up location.


   

    Drop Off Information:

    Give Address & Phone # at drop off Location


   

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.

I do understand that the 30% deposit is non-refundable in case I cancel the reservation or in case I change my mind.


   Payment:    Phone:


(e.g: 123-456-7890)

   Card Number:


(e.g: 1234-4567-7890-0000)

   Fax:


(e.g: 123-456-7890)

   Exp. Date:


(e.g: 02/05)

   Billing
   Address:

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

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

   Other payment methods accepted   Learn about payment with PayPal