Emerald Limousine Service http://www.Limo.Net 2006

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Emerald Limousine Service http://www.Limo.Net 2006











Emerald Limousine Service

http://www.Limo.Net

2006

V.I.P. Executive Limousine Service

Limo@Limo.Net

Albany/Corvallis (541)926-7617


Bend
(888)546-6638

Eugene/Springfield
(541)345-3655
181 34th Ave SW

Salem (503)362-5556
Albany, OR 97322-3849

Portland (503)972-0278
FAX (541)926-9874
Serving Western & Central Oregon Toll Free (888)Limo.Net 888-546-6638

Date of Service____________________________Limo Requested: VIP____ Driver_____________ Time of Service _______________ Am/Pm to _______________ Am/Pm Split Total Hours _____
_______________ Am/Pm to _______________ Am/Pm
Occasion ________________________________Surprise Yes/No # of Passengers ___________ Customer __________________________ H. Phone ________________W. Phone_____________
Wedding time -or- Airline, Flight# & Originating City: ______________________________________________________________Arrival -or- Wedding time: ______________________________
Name of Party _________________________________________ Contact____________________

Pick up address _______________________________________ City ______________________

Nearest Cross Street ___________________________________ Zip Code:__________________

Directions & special instructions: ______________________________________________________
If apartment complex what is the complex name
. ____________________________________________________________
________________________________________________________________________________ ________________________________________________________________________________

Additional Pickup/Drop off ___________________________________________________________
________________________________________________________________________________

Destination ____________________________________________ City/Zip:___________________

Directions & special instructions: ______________________________________________________
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
Special requests : Glasses & Ice: Beverage(s) ______________________ Other: __________
________________________________________________________________________________
Payment made by: -VISA -M/C -A/E -Disc -Bill -CASH -Check# ________________ Name as it appears on credit card: ____________________________________________________ Credit card number: _________________________________________________ Expires ________
Credit Card Billing Address: _______________________________ Billing Zip Code: _____________
Total amout on card$____________
Signature line xxxx 123 {AMX 4 digits on front}
CVV: _____________

Amount quoted: $___________________ Deposit