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
Type of Card: Type Of CardVISAMastercardDiscoverAMEX
Credit Card Number:
Front of credit card :
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
If you have questions about the contents of this document, you can email the document owner.
Document Name: Payment authorization
Agree & Sign