Name

Address

City

Zip

Home Phone

Home Fax

Office Phone

Office Fax

Brides First Name

Grooms First Name

Pickup Time

Date Desired

Ending Time

AM  or PM

Pickup Address

Destination Address

Name on Front Plate ($10.00 Extra)

(11 characters maximum)

Price

Amount Paid

Amount Due

By (Date)

Number of Persons

Is this a Surprise?

Yes or No

Champagne Service (Non-Alcoholic  $12.00 Extra)

Yes or No

How did you find our service.

Detailed Directions to the First Stop and any additional comments.

Key Map page and Square of First Stop

Page

Square

VISA M/C      Number  Exp Date

By sending Jordan Limousines this information, you certify to have read and agree to these terms and conditions.

REFUND POLICY: (Broken Engagements, Etc.) $150.00 cancellation fee anytime.
Balance refunded if 60 days notice is given.
ALL WEDDING AND PROM RESERVATIONS MUST BE PAID IN FULL 45 DAYS IN ADVANCE.
NO EXCEPTIONS!

Please include your email address

Please call for price and availability. Confirmation of reservation subject
to availability and credit card approval, and requires return of a signed contract.