(973) 306.7075
Credit Card Authorization Form
Personal Information
E Mail Address :
Confirmation Number :
Date of Service :
Name (as it appears on credit card) :
Billing Address (where credit card bill is sent) :
City :
State :
Zip :
Telephone numbers:
Home :
Work :
Ext :
Fax :
Cell :
CREDIT CARD INFORMATION
Check one :
Visa MasterCard American Express Discover
Credit Card No :
Expiration Date :
PLEASE CHARGE CREDIT CARD AS FOLLOWS:
I authorize Royal American Limousine to charge the credit card specified above the full amount of the service. In accordance with the terms and conditions between Royal American Limousine and the undersigned, I fully understand Royal American Limousine' Cancellation Policy. I authorize Royal American Limousine to process all charges accordingly.
I would like to establish a retail credit card account and authorize Royal American Limousine to process any charges for all future service. I, the undersigned, authorize Royal American Limousine to charge the above referenced credit card for transportation and related services which may be rendered through Royal American Limousine and/or its affiliates. In accordance with the terms and conditions between Royal American Limousine and the undersigned, I fully understand Royal American Limousine Cancellation Policy. I authorize Royal American Limousine to process all charges accordingly.
Please print Form then sign actual signature, date and fax.
Signature :
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Date :
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To assist us in deterring the fraudulent use of credit cards, please e-Mail an enlarged and lightened copy of the FRONT AND BACK OF YOUR CREDIT CARD AND DRIVER'S LICENSE, along with the authorization form below, to info@royalamericancls.com
