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Diplomat Limousine Service

To Reserve A Vehicle please fill out the Secure Reservation form Below

* INDICATES REQUIRED FIELDS

CONTACT INFORMATION / GUEST INFORMATION                                 

*FIRST NAME *LAST NAME

*PHONE            CELL PHONE

*EMAIL         

HOW DID YOU HEAR ABOUT US?  Email Google Yahoo MSN Other Search Engine Newspaper Our Monthly Newsletter Catalog Tradeshow Friend Co-Worker Business Card Television Radio Direct Mail Newsgroup Tourist Information Magazine Other Source

TRIP INFORMATION                                                                                         

*TRIP TYPE  AIRPORT TRANSFER HOURLY WEDDING HOURLY PROM HOURLY NIGHT-OUT HOURLY / AS DIRECTED

  IF HOURLY, HOW MANY HOURS? SELECT HOURS 2 Hrs (minimum) Town Car 3 Hrs (minimum) SUV / Stretch 5 Hrs 6 Hrs 7 Hrs 8 Hrs 9 Hrs 10 Hrs 11 Hrs 12 Hrs

*CAR REQUESTED SELECT VEHICLE Executive Town Car Mercedes Benz S-Class Lincoln Stretch 6 Pax Lincoln Stretch 8 Pax Lincoln Stretch 10 Pax Cadillac Escalade ESV / SUV 10 Passenger Van With Luggage 14 Passenger Van W/O Luggage

*NUMBER OF PASSENGERS *NUMBER OF LUGGAGE/BAGS  

PICK-UP INFORMATION                                                                                  

*PICK-UP DATE (MM/DD/YYYY)   Month January February March April May June July August September October November December / Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Year 2009 2010 2011 2012

*PICK-UP TIME (HH : MM )        - - 01 02 03 04 05 06 07 08 09 10 11 12 : - - 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60   *AM/PM AM/PM AM PM

AIRLINE (If Applicable)  FLIGHT / TAIL#

*PICK UP ADDRESS            

*DESTINATION ADDRESS 

BILLING INFORMATION                                                                                 

*FORM OF PAYMENT        VISA MASTERCARD AMERICAN EXPRESS DISCOVER DINERS CLUB

*CREDIT CARD NUMBER 

*EXPIRATION DATE (MM/YYYY)   Month 01 02 03 04 05 06 07 08 09 10 11 12 / Year 2009 2010 2011 2012 2013 2014 2015 2016

*CREDIT CARD SECURITY CODE (CVV) 

*NAME OF CARD HOLDER 

*BILLING ADDRESS               

*CITY *STATE *5-DIGIT ZIP CODE

COMMENTS / INSTRUCTIONS (If Necessary)

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