UNITED LIMOUSINE SERVICE

NOTE: Fields with "*" are required to be filled out before you can continue. Please complete all the fields as accurately and as much as you possibly can.

NOTE: Availability is based on our calendar and time. Customer is under no obligation to book a reservation. Information collected will be instantly sent via E-mail and we will contact you at the earliest possible opportunity.

1	CONTACT INFORMATION

Primary Passenger:

* First Name:

* Last Name:

Email Address:

* Phone:

( ) -

2	RESERVATION INFORMATION

* Pick-up Date:

* # of People:

* Pick-up Time:

* # of Hours:

Vehicle Type :

Pick-up From:

* Address:

* City:

* Zip Code:

Stop At:

Address:

City:

Zip Code:

Drop-off To:

* Address:

* City:

* Zip Code:

Comments:

3	PAYMENT INFORMATION

Bill To:

Payment Type:

Email Address:

* First Name:

* Last Name:

* Address:

* City:

* State

* Zip Code:

* Phone:

( ) -

4	RESERVATION AGREEMENT

1. All deposits are NON refundable. 2. Company is not liable in the event of mechanical breakdown while on charter and will only be responsible for making up lost time at a mutually agreed date. The client assumes full financial liability for any damage to the limousine caused during the duration of the rental by them or any members of their party. A fee of 100.00 for each carpet or seat burn. Sanitation fee is 250.00. Alcohol Consumption and drug use is prohibited by law. Any fines will be paid for by the customer. The Driver has the right to terminate run without refund (if there is blatant indiscretion on the part of the client(s)). It is illegal to stand through the sunroof. Smoking is not permitted in some of our limousines and this is left to the discretion of the driver. 4. Overtime pay will apply after the first 15 minutes of prearranged time described on the run sheet. 5. Not responsible for delays or the termination in winter caused by unsafe road conditions (ie. not salted, accidents, etc.). 6. Not responsible for articles left in the limousine. 7. Balances to be paid to the driver on the run date before the beginning of the run. 8. Vehicles cannot be loaded beyond seating capacity.

I agree to the above terms

NOTE: Please make sure you have read the above Reservation Agreement and that you have checked the checkbox above before you can continue.