 Authorization
to Debit Credit Card
*PLEASE RETURN THIS FORM WITH A LEGIBLE FRONT & BACK COPY OF THE ABOVE CREDIT CARD, AS WELL AS A COPY OF THE CARDHOLDER’S DRIVER’S LICENSE. THIS IS REQUIRED TO VERIFY INFORMATION AND COMPLETE THE BOOKNG PROCESS. Reservation Confirmation Number _______________ Name ____________________________________________________________________ (As it appears on the card) Billing Address____________________________________________________________________________ City________________________________State________________________Zip Code___________ Telephone: Office: ______________________ Fax:________________________ Home: ______________________ Cellular:________________________ -------------------------------------------------------------------------------------------------------------- Credit Card Information ˆ Visa ˆ MasterCard ˆ Diners ˆ American Express (CID#_________) Card Number _____________________________________________________ Date of Exp ______/______/______ I, the undersigned, hereby, authorize Royal Star Limousine Service to charge the above listed credit card account the amount for all transportation services and / or additional charges. Signature: ______________________________________________ Date: ______________________ *For reservations, a phone approval or a 50% deposit will be charged to the card at the time of the booking. The balance, (including tolls, phone charges, additional service used and purchases) will be charged to above credit card after the completion of service. Cancellations will forfeit the deposit amount. Deposit amount to be charged: $____________ Complete Contracted Amount $_____________
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