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Payment authorization

By signing this form, you give us the permission to debit your account for the amount indicated on or after the indicated date.

I authorize NYC Limo Service to charge my Credit/Debit Card indicated below

For $ on Select Date

Confirmation#:

Billing Details

Billing Address

City,State, Zip

Email

Phone #

Type of Card:

Cardholder’s name:

Credit Card Number:

Expiration Date:

Security Code:

Front of credit card :

Credit card (Front)

Back of credit card:

Credit card (Back)

Your state ID or driving license (Optional):

ID/License (Optional)

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

27 October 2023 18:25 EST

Payment authorization Uploaded by NYC Limo Service - info@nyclimoservice.com IP 116.206.64.130