Livery Service Request Form

Miller & Sons > Livery Service Request Form

"*" indicates required fields

Use the form below to request Miller & Sons Livery Service. Please note that your service request will only be confirmed when you receive a faxed confirmation from one of our team members.

CLICK HERE to download and print a copy of the Livery Request Form, which can then be faxed to 214-827-0136.

LIVERY SERVICE REQUEST FORM

Business Name:*

Business Address:

Phone:*

Fax:

E-mail Address:*

VEHICLE ORDER INFORMATION

Name of Deceased:

Contract/PO #

Director:

Ordered by:

Service Day:

Service Date:

Service Time:

Place of Service:

Address (if other than funeral home):

Place of Interment or Entombment:

Cars Requested:

Number of Coaches Requested:

Address (if other than funeral home):

Time Requested:

City:

Zip Code:

MAPSCO #:

Contact Person:

Phone #:

Number of Limos Requested:

Address (if other than funeral home):

Time Requested:

City:

ZIP Code:

MAPSCO #:

Contact Person:

Phone #:

Number of Limos Requested:

Address (if other than funeral home):

Time Requested:

City:

ZIP Code:

MAPSCO #:

Contact Person:

Phone #:

Special Instructions:

Contact Information: