Name:___________________________________________________________________________________

Pick-up Address:__________________________________________________________________________

City/Town:_____________________________________________ Phone#:___________________________

Destination:_______________________________________________________________________________

Special Instructions:________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Flat Rate:___________ Hourly:_________Deposit:______________ Amount Due:_____________________

Number of Passengers:_____________     Pick-up Time:________________________

        I,_________________________________________ accept full responsibility for any damages done while renting this

Limousine & accept full responsibility for all other persons in my party. I have accepted this limousine upon arrival and have agreed

to the above price. I will pay for all services rendered.

SIGNATURE  ________________________________________ Date:_______________________________

No Alcohol Will Be Permitted for Minors!!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

To Be Completed by Driver:

Arrival Time:_______________Drop Off Time:_________________ Amount Received:________________       Cash/Check#_________ (circle one)

Driver Name:_________________________________________ SS #:__________________________________ DOB:________________________

Beginning Mileage:_____________________________________________________ Ending Mileage:______________________________________