Name: *

Passenger Name: (if you are arranging booking for a Client or Guest)

Company:

Address:

Phone:

Email: *

Trip #1

Date: * Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2011 2012

Pick up Time: *

Pick up Location: *

Drop off Time:

Drop off Location:

Please fill out the following information if flying:

Flight #:

Luggage Type: Carry on only Baggage to Claim XL Luggage to Claim

Would you like the passenger to receive "Meet'n'Greet Service" with Sign?  Yes No

Trip #2

Date: Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2011 2012

Pick up Time:

Pick up Location:

Drop off Time:

Drop off Location:

Please fill out the following information if flying:

Flight #:

Number of Passengers: *

Contact Name:

Cell # at time of service:

Vehicle Type: Please Choose A Vehicle Sedan (1-3) SUV (1-6) Van (4-8) Stretch Limo (2-8) Exec. Mini-coach (8-22) Full Coach (50)

If there are addition trips please include that information in the Comments / Requests box below.

Comments / Requests

Payment Type:

I will issue a cheque to Provincial Car Service, please invoice me
I or the Client will provide a Credit Card upon completion of service
I will provide CC# to pre-pay so Client doesn't have to deal with payment

Notes: Additional Itinerary, Comments, Requests or Questions :

Please answer the following question before submitting the form:

Completing this form does NOT confirm a booking. We will reply with a Formal email Quote typically within 1 - 4 hours. To confirm, you will need to reply and provide a Credit Card #. At that time a formal email Confirmation will be issued. If you already have an Account, please provide your prefered payment method for this booking.

At Provincial Car Service, client security and confidentiality is of great concern. It is our policy to delete all financial information upon completion of a transaction, unless a Credit Card Account has been established for future use. In 9 years of Business we have not had one incident where data has been comprised or a Credit Card transaction has been disputed or erroneously charged.

Clean, sanitary vehicles are of great importance to us and our clients. We have our own 7000 sqr/ft building with wash bays to keep our vehicles indoors in perfect condition and appearance. The interiors are cleaned daily with anti-bacterial wipes in order to ensure and promote healthly environments for you and your guests.