Name*

Address

City

Zip

Home Phone

Cell Phone*

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. You do not get to keep plate)

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.

VISA M/C AMEX   DISCOVER      Number   Exp Date

By sending Jordan Limousines this information, you certify to have read, understand and will comply with the terms and conditions in the contract located under "rental forms".

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.