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	Order-form	Please bear in mind: Only orders that have been confirmed by Doelen, are valid !!
	E-Mail address	__ (required)
	Name of Sender	__ (required)
	Name of Company
	Name of Vessel
	please fill out :	(only if address unknown to Doelen Limousine Service)
	Address
	Zipcode	___Cityxxx
	Country
	Phone-number	( incl. countrycode )
	Fax-number
	Name of Passenger(s)
	Number of Pax
	Inward journey :
	Arrival date
	Flightnumber
	Arrival time
	Pickup point (if not airport)
	Pickup time
	End time (estimated)
	outward journey :
	Date of departure
	Flightnumber
	Departure time
	Pickup point for departure
	Pickup time
	Destination / Program
	Type of car	- Mercedes E - Mercedes 320 SEL - Mercedes V - 6 seater - Chevrolet Starcraft - 6 seater Van - Chevrolet Globesmaster 8 seater Van - Cadillac Strectch Limousine
	Your remarks (if any)
	Method of payment	American Express Visacard Mastercard Diners Other card - (see below) CASH BY INVOICE _______
	Card (if other)
	Card Number
	Name on card
	Expiry date