Haas Limo
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Call Us : (571) 235-0995
samirenaser@gmail.com
2501 South Adams Street , DMV Area 22206
Home
About Us
Vehicles
Meet Our Team
Services
Airport Transportation
Limousine Transportation
Leisure and Entertainment Transportation
Shuttle and Bus Transportation
Corporate Transportation
Meeting and Event Transportation
Diplomatic Transportation
Private Security Services
Contact Us
Home
About Us
Vehicles
Meet Our Team
Services
Airport Transportation
Limousine Transportation
Leisure and Entertainment Transportation
Shuttle and Bus Transportation
Corporate Transportation
Meeting and Event Transportation
Diplomatic Transportation
Private Security Services
Contact Us
Book Now
Personal Info
Credentials
Vehicle
Documents
Scheduling
Payment
Consent
Section 1: Personal & Business Information
Full Name (First, Middle, Last)*
Email Address*
Phone Number*
Address*
Emergency Contact Name & Phone Number*
Tax Information*
Social Security Number (SSN)
Employer Identification Number (EIN)
Tax Number*
Required for 1099 reporting. This data is encrypted and securely stored in compliance with IRS regulations.
Next: Driver Credentials
Section 2: Driver Credentials
Driver's License Number*
State of Issue*
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Expiration Date*
Years of Professional Driving Experience*
TLC License Number (if applicable)
Have you ever been convicted of a felony or DUI?
Are you currently affiliated with other transportation companies?
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Next: Vehicle Information
Section 3: Vehicle Information
Make (e.g., Cadillac)*
Model (e.g., Escalade ESV)*
Year*
Color
License Plate Number & State*
Number of Passenger Seats*
Interior Features (check all that apply)
Leather Seats
Rear Climate Control
Tinted Windows
Charging Ports
Wi-Fi
Other:
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Next: Documents
Section 4: Required Document Uploads
Upload in JPG, PNG, or PDF. Max file size per doc: 5MB
Valid Driver's License (front)*
Valid Driver's License (back)*
TLC License (if applicable)
Vehicle Registration*
Proof of Insurance (min. $1M commercial liability)*
Vehicle Inspection Report (dated within 12 months)*
DMV driving record*
Photos of the Vehicle* (Front, Back, Left Side, Right Side, Interior)
Back
Next: Scheduling
Section 5: Scheduling & Preferences
Are you available for airport pickups?
Are you available for hourly as-directed work?
What days/times are you typically available?
Weekdays
Weekends
Day
Evening
Overnight
Minimum notice required to accept a dispatch*
Select...
2 hours
12 hours
1 day
2 days
1 week
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Next: Payment
Section 6: Payment Details
Preferred Payment Method*
Select...
Zelle
ACH
PayPal
Other
Name on Account*
Email / Routing / Account # (based on payment type)*
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Next: Consent
Section 7: Declarations & Consent
I authorize Haas Limousine to conduct a background check.*
I agree to comply with Haas Limousine's dress code and professional conduct standards.*
I certify that the information provided is true and complete to the best of my knowledge.*
Digital Signature (Type Full Name)*
Date*
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