Lafayette Limo Inc / 1-765-497-3828

New Account Registration

General Information:

First Name

Last Name

Company Name

Street Address

City

State / Province

Zip / Postal Code

Home Phone Number

Mobile Phone Number

Other Information:

Username

Password

Confirm Password

Email Address

Preferred Payment Method: (optional)

Entering your payment information while creating an account is optional. However, by completing this step, you'll have your payment information at your fingertips each time you checkout!

As a registered customer, your card number is stored for you. This means that you need only enter your credit card number once!

Credit Card Type

Cardholder Name

Billing Street Address

(Same as above)

Billing City

Billing State, Zip

Credit Card Number

Expiration Date