Personal & Confidential

CRYSTAL LIMOUSINES
Credit Card Authorization Form
 

IMPORTANT:  To assist us in deterring fraudulent use of credit cards, please fax us an enlarged and lightened copy of THE FRONT AND BACK OF YOUR CREDIT CARD, and YOUR DRIVER’S LICENSE along with this form signed to (714) 279 0904 

                                                                 

 

 



CARDHOLDER NAME : ____________________________________________   SERVICE DATE(s): _____/_______/______

 

 


BILLING ADDRESS:   ________________________________________ CITY, STATE, ZIP ___________________________

 

 


PHONE:  HOME:  ______-________-____________WORK: _____-_________-_________CELL:_____-________-_________

 


CREDIT CARD INFORMATION: (Circle One)

 

 VISA        MasterCard          American Express          Discover

 

 

 
CARD NUMBER # __________________________________________________ EXP DATE: _______/_________

 

 

 

 I, the undersigned, authorize CRYSTAL LIMOUSINES  to charge the above credit card for transportation and related services to be rendered on my behalf.   A copy of this Authorization is deemed as an original. 

 

 

 

Cardholder Signature: ___________________________________                    Date: __________________