AFG Luxor Limousine Inc - Online Reservations Request Form

Date and Time:*

Full Name:*

Phone Number:*

Email:*

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Type of Service:*

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Total Hours:* Number Of Passengers:*

Address:*

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Address:*

City:* State:* Zip:*

Credit Card:*

Credit Card #:*

Expiration Date (MM/YY):* Card Security Code:*

Name Of Cardholder:*

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Total $:*

Deposit $:* Balance $:*

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	Google		Yellow Pages
	MSN		Repeat Client
	AOL		Party Pop
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	Other		Business Associate

I, the customer understand that deposits are non refundable, and all reservations made for a specific limousines are final, and will be charged the entire price of the reservation upon cancellation & authorizing A.F.G. Limo Service to process charges on my credit card for rental service, overtime & damages to the limousine. Any charges that might be incurred to the limousine by my guests or myself, I the customer take full responsibility for the asking price for rental of limousine & damage(s) to the limousine. I the customer, hereby waives any and all claims against A.F.G. Limo Service Thank you, For Your Business $ Choosing AFG Limo Service.

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Date and Time:*

Full Name:*

Phone Number:*

Email:*

Email (Confirm):*

Type of Service:*

Address:*

City:* State:* California Nevada Zip:*

Address:*

City:* State:* California Nevada Zip:*

Credit Card:*

Credit Card #:*

Expiration Date (MM/YY):* Card Security Code:*

Name Of Cardholder:*

Billing Address:*

Total $:*

Deposit $:* Balance $:*

Return date and time:

Airline:

Flight#:

Departure:

Arrival:

Comments:

How Did You Learn About Our Website?:*

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City:* State:* Zip:*

City:* State:* Zip:*