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Credit Card Authorization Form
The pertinent information is indicated below:
Account to be listed as:
*
(or name as it appears on the credit card)
Credit Card Number
*
Expiration Date
*
MM slash DD slash YYYY
CSC (Security Number)
*
Amount
*
Card Type
*
Amex
Visa
Master Card
Diners
Discover
Billing Address
*
Street Address
Address Line 2
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State
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West Virginia
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
*
Fax
Full Name
*
Email
*
I hereby authorize my signature to be on file with Paris Limousine Service for the purpose of receiving payments of having the charges for the service I receive / put on my credit card.
Card Holder's Signature
*
Date
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.
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