PLEASE CHECK ONE - PICKUP AIRPORT - PICKUP CRUISE SHIP

Company:

Name:

Address:

Contact Name:

City: State: Zip Code:

Phone: Area Code - Ext: 1-800 or 888: -

Fax: Area Code - E-mail:

How did you hear of our company?

*DEPARTURE INFORMATION*

*AIRLINES*

Connecting Flt Info: Airlines:

Flight No: Time: (am. or pm.) Gate Departure:

Transportation - Private Limousine

Qty ( + + + ) X First Two Included - No Charge

- - - Ladies - - Mens - - Teen - - Child  - Full Lei Greeting Service - - Total

Qty ( + + + ) X $100.00 each = $

For larger groups, please contact our service representative for special rates.

LIMOUSINE TRANSPORTATION ON ARRIVAL OR DEPARTURE

PLEASE MAKE SELECTION FROM BELOW

Arrival Service Date: Pick up time: (am. or pm.)

Arrival pick up address:

Destination:

Ladies - - Mens - - Teen - - Child  - - - - - Limousine Transportation Arrival

+ + + ) X Private Limo

Departure Service Date: Pick up time: (am. or pm.)

Departure pick up address:

Destination:

Ladies - - Mens - - Teen - - Child  - - - - - Limousine Transportation Departure

+ + + ) X Private Limo

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TOTAL $

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - ADDITIONAL PAXS $

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SUBTOTAL $

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - HI Tax 4.712%   $

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TOTAL DUE $

Payment: Visa or Master Card accepted through LEIS OF HAWAII

Credit Cards Type: Choose One Visa MasterCard American Express Discover

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Last 3 Digit Numbers Located On The Back Of Your Credit Card:

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Exp. Date: 00/00

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City: State: Zip Code:

Phone: Area Code - Ext: 1-800 or 888: -

Fax: Area Code - E-mail:

When complete, click "submit" to email Leis Of Hawaii. If you wish to have a hard copy of your order, please print "Form Confirmation" page after submitting. Please allow processing time. You will be contacted by your email below once your Credit Card has been approved, which will confirm your order. You will be contacted by your email if there is any problem with your order.

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