Limousine Services, Wedding, Prom, Premier Limousine Service, Powhatan, VA 23139

16,514

Virginia DMV-PC #682

Fully Licensed & Insured

Fax: (804) 598 - 1934

You Are Visitor #

We would appreciate it if you would take a few moments to answer the following questions regarding your reservations. You can also print the Adobe pdf version of this form and fax it to us at anytime.

First Name

Last Name

Home Address

City

State

Zip Code

E-mail Address

Phone:(H)

Alternates:

Date of Service

Bold = Required field

Date:

Number of Persons:

Occasion:

Pick Up Address

Pick Up Address Phone:

Directions:

Destinations:(Address)

Special Instructions:

Contact Premier Limousine Service

***Personal checks for deposit must clear 2 weeks prior to the date of event, balance due in cash only!*** Please read carefully. Passengers will be fully responsible for the following:
* A clean-up charge for spillage in the vehicle. $75.00
* A charge for broken glass. $25.00 per glass
* No illegal drugs will be permitted or used in our limousines.
* A fee of $200.00 will be charged for bodily fluid discharge.
Customer(s) responsible for any and all damages incurred by them or guests. NO SMOKING IN VEHICLE! A $100.00 clean up charge for smoking. If the Passengers are found using or carrying illegal drugs, fighting, or any other conduct not appropriate as the chauffeur sees fit, the chauffeur is under orders to return all passengers to the starting point. No refunds will be issued.
**PREMIER LIMOUSINE SERVICE IS NOT RESPONSIBLE FOR LOST OR STOLEN ITEMS!**

2751 Birdsong Lane
Powhatan, Virginia 23139
Office 804-598-1049 R. Mark Swineford
Fax 804-598-1934 804-402-3848
Where business is always Picking Up!

Reservation Form:

Click Here For Printable Form

Premier Limousine Service • A Division of Swineford Enterprises LLC • Powhatan, VA 23139