Payment Authorization Form
Elegant Limousines of Palm Coast Inc.
 Office # 386-793-1077   Fax # 386-256-5408 

Client Name:______________________________________________                                                                              

Contact Cell Phone #___________________________________________________                                                            

Email Address ____________________________________________   

Must Select Vehicle  MKZ Sedan____  XTS Sedan_____Black Dodge Charger Limo____Expedition EL Suv____
Stretch Limo Suv_____ Pink Chrysler 300 Limo                      Transit Limo                 Luxury Coach______ 

# of Passengers:___                                                                Return Time  AM / PM _____

Date of Service:______                                                           Return Date _____

Pick up Time  AM / PM_______                                         Flight Info_________________

Drop Off Time Am / PM______

Total Hours:                                                                               

Point To Point Only Check Here_____

We do not travel on ANY Unpaved Roads. No Exceptions ! 

Pickup Address and Zip Code required:_______________________________________________________________

Final Drop off Location Address and Zip Code  required:____________________________________________                                     

Address and or Names of Destinations:____________________________________________________________

____________________________________________________________________________________________ _                                                                                                                                                                                                       _______________________________________________________________________________________

Card Type: Visa / Mastercard / Amex / Discover ( Please circle one ) 

Credit Card # ______________________________________ Exp ______________ CC Code _________

Billing Address and Zip Code required:___________________________________________________    


Total Price _____________Please fill in total price of reservation. Required Field )  
Retainer:                     _Please enter 50% retainer or Full balance Due ( Required Field ) 
Balance Due                  Enter balance due if any ( Required Field ) 
Comments or Special Requests:______________________________________________________________
Elegant Limousines of Palm Coast Inc..Contract To make your time with Elegant Limousines an enjoyable one, we ask for your cooperation with the following:Elegant Limousines will strictly enforce State and Federal Laws and will maintain a zero tolerance compliance policy that no alcoholic beverages can be consumed or used by any person not of legal (21) drinking age. No person shall bring contraband or illegal substances aboard vehicles that are owned or operated by Elegant Limousines . Person(s) under the age of 21 is/are prohibited from consuming any type of alcoholic beverages. Chauffeur has every right to search the bags you are bringing to the vehicle for illegal substances at anytime. If the chauffeur finds any illegal substances, he or she has the right to terminate the contract at that moment and leave the client (s) at that location, the full amount of the booking will still be due, and no refunds will be issued. Elegant Limousines prohibits travel on unpaved roads at no time will the chauffeur operate the limo on any type of dirt, gravel or any other type road. Chauffeur has ultimate authority of where he/ she drives the limousine, dangerous and or roads that are to small to navigate can and will be avoided depending on the size of the limousine you are in. The rules cannot be modified, if a pick up or drop off location is inaccessible by paved roads it is the clients responsibility to get to and from the limousine. Elegant Limousines will not be responsible for injuries that may occur due to horse playing while the vehicle is in motion or at a standstill. Elegant Limousines will not be responsible for any Belonging‘s left while the client is in or out of the vehicle. The purchaser on the front of this contract is responsible for his or her guests. Upon determination that any of the above policies were violated, Elegant Limousines may terminate service to the client and shall be deemed to have fulfilled its contractual obligations to the client under the agreement.AT THE CHAUFFEURS DISCRETION, THE PURCHASER AGREES TO BE FULLY LIABLE FOR ALL CHARGES THAT MAY INCUR.1) $ 35.00 per broken glassware, $ 20.00 per damaged DVD(2) $ 700.00 minimum for excessive damaged seat, $ 200.00 minimum per damaged carpet.(3) $ 100.00 minimum for extensive cleanup (spills, etc..)(4) $ 500.00 shampoo and disinfecting (due to sickness interior), $ 100.00 detailing and wax (due to sicknesses exterior)(5) $ 100.00 per incident of smoking inside of the limousine, ride will be terminated after second incident. (Smoking will not be tolerated)(It is advised to allow your chauffeur to open your door)(6) It is important to remember that inciting others to cause damage to the limousine will result in charges for the damages that occur. Example yelling insults at pedestrians from the Limousine, any damage caused by the other party will be your responsibility.(7) This is not an exclusive list, any and all damages caused to the vehicle and or including loss of revenues for downtime during repairs can and will be charged to the credit card used to book this service. If there is not enough room on the credit card to satisfy the damages, Elegant Limousines reserves the right to file suit in a County of Flagler Court to recover the losses.(8) NO FOOD or Cranberry Juice will be allowed in the vehicle at any time.(9) Damage to the Flat screens will result in a $400.00 replacement fee, and charged to the credit card on file.

10) There is a $20.00 Rescheduling Fee and will be charged to the card on file. The Radio and all of it's components such as cd/DVD player, speakers and amplifiers that are damaged will be replaced and the credit card holder will be responsible for all costs and down time caused by clients. Any Excessive damage will be assessed by Elegant Limousines of Palm Coast , the assignee of this contract agrees to pay the amount assessed by Elegant Limousines. Each Booking is Exclusive and is for 1 party only and all bookings require points of Destinations ( No Aimless driving around ). Elegant Limousines prices the reservation according to the itinerary you provide, if there are travel changes that result in toll charges or additional fuel usage you will be charged a minimum of $35 and any additional fuel used for changed travel plans,and the total amount of tolls. If you are offered a free hr for local service 
( Palm Coast & Daytona Beach Only and you travel outside said areas, you will be charged a minimum of $35 for fuel. Elegant Limousines reserves the right to terminate this or any other contract for noncompliance of the above requests, especially if renters do not follow chauffeurs requests to obey the rules in this contract. Chauffeur has every right to terminate the contract if the rules are not followed. No smoking is allowed in any of our vehicles. The open balance is due 48 business hrs ( M-F 9 am-4pm )  prior to service date and will be charged automatically to the credit card on file. This contract authorizes the immediate charge of a 50% retainer & the final payment, states that she/he is the authorized purchaser for this rental contract, the authorized cardholder for given credit card, responsible and liable for payment of the total amount, ,by credit card / debit card . No personal or business checks or money orders will be accepted. Elegant Limousines cannot guarantee the availability of overtime. It is of particular importance that the purchaser makes allowances for anticipated delays and adheres to the agreed time schedule. In the event that the purchaser wants to change the time of the itinerary, they may do so, only if Elegant Limousines can accommodate other clients that booked with Elegant Limousines prior to or after the said time. The purchaser further agrees to pay additional charges incurred such as overtime, tolls, parking etc. Overtime fees are based on the hourly rate you paid for on your invoice plus a 20% service fee and is billed in 1/2 hr increments. If gratuity is not included on your invoice or offered to the chauffeur a charge of 20% of the total bill will be charged to the credit card on file. You are not billed for gratuity on free hours given or overtime. Please tip your chauffeur direct for free hour or overtime. If tip is not given on  free or overtime hours you will be billed 20% on the hourly rate. The purchaser authorizes Elegant Limousines to charge any additional charges after they have rendered services to the purchasers credit card as supplemental charge. Once the contract is signed it cannot be canceled. If you do not wish to use our services we keep the 50% retainer . Cancellations made before 15 Business days of your service date will not be responsible for the remaining balance if any . Any contracts canceled within or less than 15 business days until the service date will be responsible for the full amount of the balance due if any . Once the reservation is paid in full there will be no refunds given. If cancellation occurs before the 15 business day policy , no credit to use the service will be issued. A credit may be issued to use the service within 3 months of the original service date and is based on availability, only if you cancel with more than a 15 business days notice. I am satisfied with the terms and conditions above and fully understand and agree to the terms . Elegant Limousines guarantees, that all our vehicles are constantly checked to keep the highest possible standards . Elegant Limousines agrees to send the requested vehicle as offered in the contract. We have the right to upgrade the vehicles or switch the vehicles in case of emergency breakdown or if vehicles were in accidents. As stated, this will only happen in emergencies. No additional charges will occur on customer side if upgrade is made without customer request. If switching occurs in the same category, or upgrades are made, it will not affect the contract and / or payment of contract. Customers therefore accepts that replacement limousine may be substituted if contracted limousine becomes unavailable for any reason. If any of our above guarantees or contracted terms cannot be met due to conditions outside of our control, including weather, accidents, storms and any other acts of god, including, but not limited to traffic congestion, road closures, accidents, flight delays, etc.., we will use our best efforts to notify the customer of these conditions and resulting delays or changes. In case of non-payment or any disputes of charges resolved from things like damaged car or overtime, etc, I agree and fully authorize the charges to be put on my credit card provided above. By agreeing to these terms and conditions and providing your credit card information, you are authorizing Elegant Limousines to charge your credit card for any of the following charges: retainer , all services rendered, and any damages done to the vehicle. The balance owed is due upon 48 hrs prior to the date of service. Any overtime hours or fees as a result of damage to the vehicle will be calculated and billed within 48 hours of the completion of the trip. You will be notified of any additional funds that will be required.Contract Obligations: I understand and agree to the length and usage along with any charges and further agree to pay for any and all damages my party may cause during the rental periods. I also agree to the above Terms and Conditions. All damages are the sole discretion of the driver. I understand and agree to pay the entire contract price if the cancellation policy is not followed. The number of hours agreed to on the contract is the minimum number of hours client agrees to pay. By signing below you forfeit your right to dispute the charge via your credit or debit card company for terminated rides due to prohibited actions by the client

Signature X______________________________________________________________________Must be the credit card holder's name. Will be verified upon arrival at pick up location. 
We Do Not Accept Digital Signatures. 
Signature Must Be Legible or Contract Will Not Be Accepted !
Print Name:                                                              ___Date: _                            ______________________