Credit Card Authorization Form

Member first name:___________________________________________

Last Name__________________________________________________

Address where you receive your credit card bill.


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: __________

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Posted under by Dallas-Limos on Thursday 28 January 2010 at 10:40 pm

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