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New York Limousine Service

Fax Reservation Form

Please fill out this New York limousine service form on line, then click the "PRINT" button below.

Call us to recieve Fax Number

This NYLIMOCOACH FAX form is arranged for New York airport limousine service.

For other service, please fill in your special request in the comment box below

Street Address or Airport Name:

Address2 or Airline Name

City or Arriving From:

State/Providence or Flight No.:

Zip/Postal Code or Arrival Time:

Destination:	Other:
No. Passengers:	Handbags: Suitcase: NOTE: OVER 8 SUITCASES WILL REQUIRE THE LUXURY VAN.
Type of Car:
Date of Pickup:
Time of Pickup:

Credit Card Type:
Credit Card Number:	Exp Date: (mm/yy)
Name on Card:
Card Billing Address:	City:
State:	Zip:
Card Holder Phone:

By signing this limo service form you agree that (1) you are the credit card holder and (2) that you are requesting the services listed above and (3) that you are authorizing this card to be used for the New York limousine service requested.

Cardholder's Signature: _________________________________ Date: ___________