Serving NJ, NY,
PA, CT and Florida
NJ FAX (908) 233 7576
FL Fax(727) 517 4470
reservations@geminilimo.com 800
842 9004 www.GeminiLimo.com
Car Type (circle one) SEDAN LIMO VAN # of Passengers______
Pickup Info: DAY:
Mon Tue Wed Thur Fri Sat Sun
Date:_________________
Pick up Time :________ am pm
(circle one)
Passenger Name:___________________________ Airline:_________
Pick Up Address:____________________________________ City:_____________ State:_________
Drop off Address:____________________________________ City:______________ State:________
General Directions
(add extra sheet if needed)_____________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Person Calling:________________________ Caller Phone #:_______________________
Passenger Phone #:_________________________ Confirmed By:_____________________
Payment Method: (circle one) Cash Visa Amex MasterCard Diners Club Discover
Card #:____________________________________________________ Exp Date:__________
Rate _______________ Plus 20% Gratuity and Tolls
Customer: (please circle
one) New
Current
_________________________________________________________________________________
RETURN:
Indicate airport _____________________________
DAY: Mon Tue Wed Thur
Fri Sat Sun Date:_________________
Flight #:________
Airline:________________ Arrival Time:__________am. pm. From:_____________
Curbside/Pickup Inside/Pickup
If not an airport
trip then indicate
Drop off
Address:____________________________________ City:______________
State:________
Cell Phone
#:______________________ Rate___________
Plus 20% Gratuity and Tolls
Pick up Assistance Number 800
842 9004
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