Please fill in the following information, note items in white are required, yellow are optional How did you hear about us:   Make Selection Referral Google YahooMSN LimoPros.com Limos.com LimoRaces.com Saw Limo Driving / Parked Yellow Pages Other        Pickup Date:  . JanFebMarAprMayJuneJulyAugSeptOctNovDec  . 12345678910111213141516171819202122232425262728293031  . 20082009 2010 2011 2012     Pickup Time: . 12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30    . ampm     Event Type: Make Selection Airport Transfer Cruise Port Transfer Night on the Town PromWeddingSchool Dance BirthdayBachelorBacheloretteAnniversaryGraduationConcert Sporting EventOther Service   Vehicle: Make Selection Cadillac Escalade ESV 20 Pass Limousine H2 Hummer 20 Passenger Limousine Lincoln Town Car Limo 10 Pass Lincoln Town Car Limo 12 Pass Cadillac Escalade ESV 6 Pass Non-Stretch SUV Lincoln Town Car Sedan 3 Passenger Limo Party Bus 28-30 Pass     Number of Hours Needed (Hourly Service Only): Promotion Code for Free Hours or Special Rate: First and Last Name : Contact Cell Phone Number:  Backup Phone Number:   Email Address:  Pickup Address: (if pick up is an airport or cruise port just enter the airport name in the box below) Street:  City:   Suite or Apt #:   State:    Zip Code:       Destination Address:  Street:  City:   Suite or Apt #:   State:    Zip Code:         Special instructions or multiple pick up addresses, if booking an airport run please enter your Airline, arrival time, and Flight Number:          Quote From: Make Selection Telephone Google E-MailLimos.com Quote Requested       Quoted Price:   / hour, or flat rate Type of Credit Card:  VisaM/CAMEXDiscover      Credit Card Number:     Expiration:  . JanFebMarAprMayJuneJulyAugSeptOctNovDec/ .200820092010201120122013      Security Code:  Name on Card:             Billing Address: Street:  City:   Suite or Apt #:   State:    Zip Code:       Daytona Limos looks forward to providing you with the best possible limousine service.  You will receive a confirmation email and phone call to confirm your booking. If you do not receive a confirmation with in 24 hours contact us to ensure there are no problems with your reservation. Reservations will not be accepted that do not meet our hourly minimums, incorrectly entered hourly rates, and or invalid payment information. By submitting this reservation request form I hereby authorize Daytona Limos to charge my credit card provided above for the following charges: A nonrefundable deposit equal to 25% of the total rental cost, (special events and proms may require a higher deposit) The remaining balance is upon pick up from your location. Chauffeurs are equipped with hand held credit card scanners for your convenience, The card holder and card entered above must be present at the time of pick up. If you are paying via cash please notify Daytona Limos two days prior to pick up to ensure the office knows about your payment. Personal or business checks cannot be accepted at time of pick up, If you choose to pay by a personal or business check it must be done 5 business days prior to pick up, checks that do not clear can result in the cancellation of your booking and forfeiture of any and all deposits paid to Daytona Limos Overtime hours, damages and or incidentals as listed on your rental contract. I have read and agree to the Daytona Limos Contract and agree that submitting this form consents as an Electronic Signature. Agree with Contract & Electronic Signature: NoYes