CREDIT CARD AUTHORIZATION FORM VIP EXECUCAR LLC.
Caution: After you fill out this form, print, sign and submit it to VIP EXECUCAR office. 
Date:
CREDIT CARD TYPE:

AMEX
VISA

MASTERCARD

SIGNATURE DETAILS

     
CREDIT CARD NUMBER:
EXP:
CID VISA-MC:
  CID AMEX:
COMPANY NAME:
CARD HOLDER NAME:
CREDIT CARD BILLING ADDRESS:
CITY/STATE/ZIP:
PHONE:
    --   
FAX:
    --   
Your Email:
AMOUNT CHARGED:
$
NOTE:
 
I,
 hereby authorize my credit 
to be charged for the above amount. I read and agree to all the cancellation quidelines (terms & conditions) listed at http://www.vipexecucar.com/terms-contidions.html that apply to my reservation.In addition, I authorize VIP EXECUCAR LLC to charge the credit card indicated above for any additional balances, overtime, or additional use of service, or damages that I  may occur during service. I will not dispute this charge. I affirm my obligationsunder the card member's agreement.

Please fill this form, and fax back or e-mail this form with a copy of the front and back of the credit card, as well as a copy of the Driver License of the authorized person.

 

Sign: _____________________________________ Date