678-377-1700

1-888-963-2227

You can complete this online form and send it to us, or you can download the Microsoft Word Document and fax it back to us at 678-377-1742

Company Information

Legal Company Name:

 

DBA/Trade Name:

 

President:

 

V.P.

 

Treasurer:

 

Comptroller:

 

Total # of Employees:

 

Full time:

Part time:

Address

Address:

 

City:

 

State:

Zip:

Phone:

 

Fax:

Toll-Free:

 

e-mail:

Billing Contact:

 

Phone:

Dispatch Contact:

 

Phone:

Trade Reference

Company:

Contact:

Address:

Phone:

Company:

Contact:

Address:

Phone:

Company:

Contact:

Address:

Phone:

General Information

Insurer:

Contact:

Policy #:

Phone:

Credit Cards Accepted

American Express

Visa

MasterCard

Discover

Diners Club

Other

Are you a member of Limousine Associations?

 Yes     No  Who?

Are you currenlty affiliated with any Networks?

 Yes     No  Who?

Do You offer 24/7 service?(with 24hour notice)

 Yes     No

Do You Have 24/7 Phone Coverage?

 Yes     No

Do you utilize reservation software?

 Yes     No

Do you have internet access?

 Yes     No

Do you have a website?

 Yes     No  Address

Do youre drivers attend Chaufeur Training?

 Yes     No

Territory Information

Airports Served (Please provide a copy of airport permit if required)

1.)

2.)

3.)

4.)

States Served (Interstate Approved)

1.)

2.)

3.)

4.)

Fleet Information

Vehicle Ownership:

Company

Types of Vehicles:

Owner/Operator

Franchise

# of Sedans:

# of 8 Pax:      

# of 6 Pax:  

# of 10+ Pax: 

# of 8-15Pax Vans:

# of Exec. Coaches 16-24 Pax:

# of 25 Pax Bus:

Other:

Vehicles Equipped With:

Radios

Cellular Phones

Pagers

Nextel

Comments: ( please provide us with any other information that we may need to know)
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