NYC Limo Services

Payment authorization


Sign and complete this form to authorize NYC Limo Service to make a one-time charge to your Credit/Debit card listed below.

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    

Confirmation#:  

 

Billing Details

Billing Address

City,State, Zip  

Email

Phone #

Credit Card Information

Type of Card:

Cardholder’s name:

Credit Card Number:


Expiration Date:  

Security Code:

 

Front of credit card :

Back of credit card:

Your state ID or driving license (Optional):




Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Payment authorization
lock iconUnique Document ID: b077bb68c441ba0dd8bb8f095768e0a1682ee68a
Timestamp Audit
10/27/2023 18:25 EDTPayment authorization Uploaded by NYC Limo Service - info@nyclimoservice.com IP 116.206.64.250