CONNECTICUT LIMOUSINE RESERVATIONS
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© Copyright 2011 Connecticutlimoct.com All Rights Reserved.  Terms  |  Credit Authorization Form                                                  By: GraphixImage
Contact Information
Full Name: *
Phone Number: *
Email: *
Email (Confirm): *
Transportation Service Information
Type of Service: *
Please Select Your Vehicle Type: *
Total Hours: *
Pick Up Info
Address: *
City: *
State: *
Number Of Passengers:*
Date: *  
Time: *
Destination
Address: *
City: *
State: *
Date: *  
Time: *
Airport Service Information
Must complete section below for airport reservations
Airport:
Airline/Flight Number:
Service Options:
Return Information
The section below must be filled for round-trip booking
Drop-Off Instructions:
Payment Information
Credit Card: *
Credit Card #: *
Expiration Date: * MM/YY
Card Security Code: *
Name Of Cardholder: *
Billing Address: *
Comments:
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I have read and agree to the terms and conditions.

I understand that deposits are not refundable due to client cancellation, and authorize Avery Limousines to process
        charges to my credit card for rental service, overtime & any damages that might be incurred to the limousine by my
        guests or myself. I the customer take full responsibility and hereby waive any and all claims against Avery Limousines.