Passenger Information

First Name:

Last Name:

Street Address:

City:

State:

Zip:
Country:
Mobile Phone:
Phone:
   

Enter your email:

   

Re-enter your email:

NOTE: Confirmation sent to this email

Pickup Information

Street Address or Airport Name:
Address2 or Airline Name:
City or Arriving From:
State/Providence or Flight No.:
Zip/Postal Code or Arrival Time:
(24 hours mode, example 16:35)
Destination Information
Destination:
Other:
Address:
City:
No. Passengers:
Handbags:
*Suitcase:
*NOTE: 5 or more suitcases will require Luxury Van or Limousine.
Type of Car:
(ex: Jan.21.2002 to insure correct Date)
Date of Pickup:
 
Time of Pickup:
Current Time: 1:30:12 PM  
Credit Card Information (leave blank if requesting a price quote)

Card to Charge:

Credit Card Issuer

Credit Card Type:

Credit Card Number:

Expiration Date

CVV2:

Name on Credit Card:

Card Billing Address:

City:

State:

Zip:
Card Holder's Phone:
Additional Information:
(return, special needs, etc)

For Verification, enter the text below:

 

 

  Regency Limousine offers a complete selection of late model cars, trucks, and buses with a wide range of seating capacities for your special day.  
Our Chauffeurs are fully licensed and highly trained professionals...

Extensive Background checks
Randomly Drug Tested
Professionally Dressed
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