Credit card authorization form Fort Worth Limos

Member first name:_______________________________________________________

Last Name_____________________________________________________________

Address where you receive your credit card bill.

Street:________________________________________________________________

Billing city: _____________________________________________________________

State _________________________Zip Code_____________________________

Phone___________________ Cell __________________ Work ______________

Circle One: Visa ———– MasterCard ———- Amex———- Discover

Credit Card #_____________________________________Expiration Date: __________

$ AUTHORIZATION AMOUNT $_____________________________________________

Place a copy of front and back of credit card in the space below along with your picture identification (i.e your Driver License) and Fax Form to 972-840-1280.  I, the undersigned, hereby authorize Angel Limos. Dallas TX to automatically deduct payment from the credit card listed above to cover all charges incurred in relation with my transportation service on behalf of ________________________________ (passenger’s name).

Card member signature: ____________________________________ Date: __________