Safety Product Order Form--LIMO

LIMO SAFETY PRODUCT ORDER FORM

Don't get caught short! Make sure your limousines are fully equipped!

Please use this form to order extra:

•	Accident Kits
•	Driver Wallet Cards

FREE FOR POLICYHOLDERS ONLY!!!

Accident Report Kits
Front - - - - Wallet Card - - - - Back
Please send me more of the following FREE items:
Accident Report Kits:
Driver Wallet Cards:
Your Name:
Policy Number (optional):
Company:
Company Address:
P.O. Box:
City:
State:		Zip:
Tel:	( )
Fax:	( )
Email:

Please click on the "submit" button below to send this form electronically.
For any questions please call our Customer Service Department at
1-800-782-8902 ext. 3307