Credit Card Authorization Form

NOTE: Items marked with an asterisk are required

First Name

Middle

Last Name

Company Name (optional)

Phone Number

Credit Card Number

Expiration Date

CVV

Billing Street Address

Authorization form agreement

I understand that submission of this form authorizes 123 Corporate Transportation to charge the listed credit/debit card for the charges incurred with my reservation I am aware that this card will also be saved until after the completion of my trip. Upon final vehicle inspection by 123 Corporate Transportation, I acknowledge that there may be additional charges for incidentals including, but not limited to, broken or missing items, damage to any area of the vehicle caused by myself or by my party, excessive clean up, loss of a bodily functions, extra stops, or overtime. I authorize 123 Corporate Transportation to settle any outstanding balance on my account with this credit/debit card I am providing here after I review an updated invoice. I agree that this card shall serve as my official payment method for all overages or extra charges, and at no time shall any financial agreement be made between the driver and myself without prior authorization from 123 Corporate Transportation administrator. I am aware that I may provide a different card or payment method for overtime or incidental charges, but that I must do so before my trip begins.

Please upload image of credit card (front & rear) + card holder's ID