Reservation Form                        Tri-State Limo, Inc (516) 933-4759
   * - required Fields                                                                  Fax: (516) 932-0431
Occasion: *
First & Last Name: *

Email: *

Contact Cell Phone Number: *

Phone # at the time of the pickup
Please don't list hotel's number

Alternate Phone Number:

Fax Number: 



AIRPORT PICKUPS:
Airport:
Airline:

Arriving From:

Flight #:
    		Time In:
    		Luggage #


Return to Airport:
Pickup Date:
    		Pickup Time:
   
Pickup Time:*
  		   Pickup Date: *

Vehicle Type: *  
Num of Passengers: *                             
Number Of Hours Needed For:                   

One Way Round Trip As Directed *


PICKUP DETAILS:
Pickup Address: *

Drop-Off Address: *

Comments/Instructions:

How did you hear about Us: *
I, hereby authorize Tri-State Limo, Inc. to charge the above listed credit card account the amount indicated on my contract, and that I will in good faith, make good on the contracted charges.

I, the undersigned, do hereby personally guarantee payment of the full contracted amount in the event of non-payment without just cause by the above named company.

This information is being taken for the confirmation/cancelation reasons. Driver will take an imprint of the card and a signature at the time of the pickup and charge the card then.
Type of Card: *
    Credit Card Number: *
   		       Expiration: *
   / 		       Security Code: *
        
Name on the Card: *
     VISA/Master | AMEX
Billing Address: *
  
Print This out and Fax it to Us at (516) 932-0431