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Limousine Service Information

Full Name: *

Phone Number: *

Email: *

Confirm Email: *

Transportation Service Information

Type of Service: * —AirportCorporateTour PackageHourlyCharterWine TourLeisure

Please Select Your Vehicle Type: * —Mercedes S550Lincoln Town CarNavigator Executive SUVSuburban Executive SUV14 pass Mercedes Sprinter Van10 passenger MKT Stretch30 Passenger Party BusBUSES25 passenger Mini Bus30 Passenger Mini Bus38 Passenger Mini Bus54-57 Coach Bus

Total Hours: *

Special Requests:

Pick Up Info

Address: *

City: *

State: * —GeorgiaOther

Number Of Passengers: *

Date: *

Time: *

Destination

Address: *

City: *

State: * —FloridaOther

Date: *

Time: *

Drop-Off Instructions:

Payment Information

Credit Card: *—VisaMaster CardAmerican ExpressDiscover

Credit Card #: *

Expiration Date: * MM/YY—010203040506070809101112—201620172018201920202021202220232024202520262027202820292030

Card Security Code: *

Name Of Cardholder: *

Billing Address: *

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  I have read and agree to the terms and conditions.

  I understand that deposits are not refundable due to client cancellation, and authorize www.platinumlimo4u.com to process charges to my credit card for rental service, overtime & any damages that might be incurred to the limousine by my guests or myself. I the customer take full responsibility and hereby waive any and all claims against www.platinumlimo4u.com.