NewYorkLimo.com Fax Reservation-Authorization Form

Please fill out this form on line, then click the "PRINT" button below.
Fax this form along with the front and back copy of your credit card to: 1-347-402-2203.
 

Passenger First Name:

Last Name:

Street Address:

City:

State:

Zip:

Country:
Phone:
 Mobile Phone:

Your Email:

NOTE: Confirmation sent to this email


 
Street Address or Airport Name:
Address2 or Airline Name
City or Arriving From:
State/Providence or Flight No.:
Zip/Postal Code or Arrival Time:
 (ex:16:30 = 4:30PM)

 
Destination:
 Other:
No. Passengers:
 Handbags: *Suitcase:
*NOTE: Over 8 suitcases will require the Luxury Van.
Type of Car:
Date of Pickup:
 Correct Date
Time of Pickup:
 Current Time:

 

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 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 requested services.

Cardholder's Signature: _________________________________________ Date: ___________


Fax the front and back copy of your credit card to: 1-347-402-2203.