VA EXECUTIVE SEDAN & LIMOUSINE SERVICE | Credit Card Authorization

 

Important:  To assist us in deterring the fraudulent use of credit cards, please fax 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 757-716-1060 .


-- Credit Card Authorization Form --


E Mail Address:             

Confirmation Number:      Date of Service: 

Name (as it appears on credit card): 

Telephone numbers:

Home:   Work: ext:

Fax:        Cell:

CREDIT CARD INFORMATION

Check one: Visa    MasterCard    Diners    Discover    AMEX

Card Number:    Exp. Date: Security Code:

Billing Address (where credit card bill is sent):     

City:   State:   ZIP:  

PLEASE CHARGE CREDIT CARD AS FOLLOWS:

  I authorize Va Executive Sedan And Limousine Service www.VaExecutiveSedan.com to charge the credit card specified above the full amount of the service.  In accordance with the terms and conditions between Va Executive Sedan And Limousine Service and the undersigned, I fully understand Va Executive Sedan And Limousine Service's Cancellation Policy.  I authorize Va Executive Sedan And Limousine Service to process all charges accordingly.

  I would like to establish a retail credit card account and authorize Va Executive Sedan And Limousine Service to process any charges for all future service. I, the undersigned, authorize Va Executive Sedan And Limousine Service to charge the above referenced credit card for transportation and related services which may be rendered through Va Executive Sedan And Limousine Service and/or its affiliates.   In accordance with the terms and conditions between Va Executive Sedan And Limousine Service and the undersigned, I fully understand Va Executive Sedan And Limousine Service Cancellation Policy.  I authorize Va Executive Sedan And Limousine Service to process all charges accordingly.

Please print Form then sign actual signature, date and fax.

Signature: ----------------------------------------------------------------        Date: ----------------------

            Name:    Phone #: