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First Name:
(Required) |
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Last Name:
(Required) |
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Address:
(Required) |
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Daytime Phone:
(Required) |
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Evening
Phone: |
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Fax
Number: |
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E-mail Address:
(Required) |
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What type of
vehicle is requested? |
6 Passenger
8
Passenger Black Tux |
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10 Passenger Limousine Black |
10 Passenger Limousine White (Tuxedo) |
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What day is the
reservation for? |
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Time of day for
pick-up: |
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Time of day for
drop-off |
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| Details (pickup location, city, directions, etc.): | |
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| Activities or Occasion: | |
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Airport Information
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Airline
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Flight
Number |
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Arrival or
Departure Time: |
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Arriving
From/Departing To: |
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Baggage: |
Yes No |
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Corporate: |
Yes No |
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Special
Requests |
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Gift
Rose Sign Ice Soda |
Other |
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Credit Card Number:
(Required) |
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Expiration Date:
(Required) |
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Credit Card Type:
(Required) |
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Name on Card:
(Required) |
Encore Limousine Company
License TCP-4875-P
Office: 1-323-753-4437 • Fax: 1-323-753-4557
Pager: 1-323-339-1743 • E-mail: WScott8419@sbcglobal.net