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For the person who has everything...Give an Escort Limousine Gift Certificate!

Gift Certificate Request Form


Contact Information

TYPE IN ALL INFORMATION, PRINT OUT, SIGN, AND SUBMIT FORM BY FAX TO: (920) 494-3840.
Your ELS Gift Certificate will be mailed to you within two weeks. Thank You!

Full Name............
Street Address.....
City.....................
State...................
Zip......................
Home Phone.......
Cell Phone..........
Work Phone........
E-mail.................
Fax....................


Recipient Name:

Gift Certificate Amount:(minimum amount $200)

5% tax will be added to amount in box above

**Gift Certificate is valid 1 year for standard limousine rental rates only,
and can not be applied/credited to chauffeur gratuity, or exchanged for cash.
All sales are FINAL. Please pay gratuity separately to chauffeur (suggested 15-20%).

Credit Card Information

Name on Card.............................

Billing Addres of Cardholder.........CityStateZip

Charge Card #............................

Expiration Date...........................

3-digit Code on Back...................

MasterCard
Visa
Discover
American Express

Signature ____________________________________________ Date ________________

PLEASE make sure all information is correct and form is signed before faxing!

Comments/Questions: