Reservation Form

	CONTACT INFORMATION
First Name
Middle Initial
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

	ORDERING INFORMATION
Type of car	4 Door Car Mini Van
Over 25 years old	Yes No	There is a surcharge of $10 per day for drivers under 25yrs.
From Date	MM/DD/YY
To Date	MM/DD/YY
	BILLING
Credit Card	VISA MasterCard American Express Discover
Cardholder Name
Card Number
Expiration Date
	DRIVER'S LICENSE INFORMATION
Name of Driver
DL#
State
Expiry	MM/DD/YY
Driver's Birthdate	MM/DD/YY
	OTHER INFORMATION
Name of Hotel or Villa  where you will be staying

	PICK-UP INFORMATION
Airline	American Delta Air Sunshine Liat Other
If Other Specify
Flight #
Time of Arrival
Date of Arrival
Number of People

	COMMENTS