Reservations form
verisigncreditcard

* indicates required fields 
  *Name:
  *Pick up Address:
  *Town of pick up:
  *Drop off Address:
  *Town of drop off:
  *Main Contact phone number:
  *Is this a cell or home phone:
  *Email address:
  *TO RESERVE FOR MARCH 2010:
  TO RESERVE A RETURN TRIP FOR MARCH 2010:
  TO RESERVE FOR APRIL 2010:
  TO RESERVE A RETURN TRIP IN APRIL 2010:
  *TIME OF PICK UP FOR MARCH:
  TIME OF REPICK UP FOR MARCH:
  TIME OF PICK UP FOR APRIL:
  TIME FOR REPICK UP IN APRIL:
  *ARE YOU PAYING CASH? OR CREDIT CARD?:
  *Cash payers will still need to provide valid card#:  Your card will not be charged for this fare if you are paying cash! A cash reciept will be provided
  *How many people are traveling with you?:
  *How much luggage do you have?:
  *Are you traveling with a pet?:
  *Your credit card number:
  *Experation number:
  *CVC # this is the three digit # back of card:
  *American Express users has a 4 digit CVC #:
  *Full name as it appears on your card:
  *Address associated to your credit card:
  *City:
  *State:
  *Zip Code:

Thank you for choosing Aggressive Shuttle Services Inc.

Your credit card and personal information is 100% secured through  Verisign on our encrypted terminal. All information is for the use and purpose of Aggressive Shuttle Services Inc. to gain information and payment of each reservation submitted by it's customers and is only used for that purpose! No other information is exchanged or shared for the purpose of marketing or exchanges of vital information to credititors or solicitation companies!

You hereby authorize Aggressive Shuttle Services Inc. Permission to process your reservation and payment. All reservations and payments will be processed and confirmed with in the hour you submit this form.

Est. 2005
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