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Cosmopolitan-Limos.com Reservation Page

Please Fill In The Following Information


First Name: * Last Name: *
Street Address: * City: *
State/Prov: * Zip/Postal: *
Country: *    
Phone: *    
Fax: (Some transactions require completion of a Credit Card
Authorization form, if we fax you one please fill it out
and fax it back to us within 24 hours.)
Mobile Phone: Your Email: *

Pick Up Information
Street Address or Airport Name: *
Address2 or Airline Name: * required for airline name only
City or Arriving From: *
State/Providence or Flight No.: *
Zip/Postal Code or Arrival Time: * (example: 16:30)
List Passengers:
Destination
Destination: *
Other:  
Address: City:
State/Prov: Zip/Postal:
Number of Passengers: Suitcases:
  *NOTE: 6 or more suitcases will require Luxury Van or Limousine.
Type of Car: *
Date of Pickup: *    
Time of Pickup: *    
Drop Off Time: *    

Credit Card Information


Please fill out the following information.
Credit Card Type *    
Credit Card Number: * Exp: *  (mm/yy)
Name on Credit Card: *    
Card Billing Address: City:
State/Prov: Zip/Postal:
Card Holder's Phone: *    
Additional Information:
(return, special needs, etc)

Please keep this Credit Card information on file for future services.

Comments


By Checking this box you have agreed that you have viewed Cosmopolitan-Limo's Terms and Conditions


You will need a valid credit card to place a reservation (unless you have an existing account).
If the credit card won't be available for imprint by driver either at the pickup or drop-off location,
we must then get a credit card authorization form by fax or e-mail from the credit card holder.


View Terms and Conditions

By submitting 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.


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