CONTACT INFORMATION

Contact Name:

Contact Phone Number: () - -

E-mail:

Company Name:

Address:

City:

State:

Zip:

TYPE OF VEHICLE

13 Passenger Van	22 Passenger Bus
55 Passenger Bus	3 Passenger Sedan

Pick Up Point:

Date:

Directions:


Destination:      Date:

Directions:


Due Back Date and Time:

TYPE OF CARD

American Express      Visa      MasterCard      Discover



Privacy Statement: The information which you give in completing this form will be forwarded to the designated party for its use and will not be used by George's Motor Coach for any other purpose.


Copyright © 2004 All Rights Reserved.