ON LINE PROM CONTRACT FORM

PLEASE CHECK AVAILABILITY BEFORE PROCEEDING

By calling (630) 679-1000

We will mail you a paper copy of this contract,

and you MUST return a signed copy,

along with a 20% deposit per limousine.

Today's Date: Month 1 2 3 4 5 6 7 8 9 10 11 12 Date 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 2004 2005 2006 2007 2008 2009 2010                         ◊  Prom Date: Month 1 2 3 4 5 6 7 8 9 10 11 12    Date 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 Day of week Friday Saturday Sunday Monday Tuesday Wednesday Thursday    Year 2004 2005 2006 2007 2008 2009 2010

I understand that filling out this contract commits me to use Platinum Chauffeur for my Prom Night   Choose One Yes No Quote Only

Placed By, MUST BE PARENT: Choose One Placed By Mother Father Other     Others, please specify:

Parents Name:

Parents Address:       Parents Unit # 

Parents City:     State: IL IN WI      Zip Code:

Parents Home Phone       Parents Cellular      Parents Work

I the parent agrees to keep their cellphone on if I leave my home as a means of emergency contact. Choose Yes NO

List all children's names that you are allowing to ride in the limousine, in the area provided below.

                  Names Listed                                 Parents Phone #

1)        

2)        

3)        

4)        

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Mail Contract to;

1st Limo Pick Up Time:

1st Limo Pick Up Location:

Time of Your Prom:

Prom Location and address:

Picture Location and When:

List Any Extra Stops Needed:

After Prom pickup Time:

After Prom Destination and address:

What time will you need your limo until;

Special Instructions:

 Limo Color: White Black    Limo Size: 10 8 6

How did you hear out about us? Choose One Better Business Bureau Davids Bridal Dream Weavers Friend Garden Wedding Chapel Limo Pros Limo Races Newspaper Ad Web Search Engine Wedding Magazine Yellow Pages Other, please specify

Other, Please specify;  

Price we quoted to you on the phone: Choose One $120 per hr $115 per hr $110 per hr $105 per hr $100 per hr $99 per hr $95 per hr $90 per hr $85 per hr $80 per hr         Flat Rate Quoted:

Rate this on line experience:

I understand that I must return a signed copy of the contract mailed to me, and this online contract guarantees my prom limo

and I will fulfill our end of this contractual agreement with A Platinum Chauffeur, Inc. Choose Yes NO

Now click submit below to complete this contract