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Credit Card Authorization Form

This document is an authorization form for Golden Limousine, Inc. to charge a customer's credit card for services. It requests the customer provide their name, billing address, credit card details including number and expiration date. The customer authorizes Golden Limousine to charge the credit card for agreed upon prices and any additional charges if the services exceed the authorized amount. The customer signs and dates the form to allow Golden Limousine to process credit card payments.

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Alexander Weir-Witmer
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144 views1 page

Credit Card Authorization Form

This document is an authorization form for Golden Limousine, Inc. to charge a customer's credit card for services. It requests the customer provide their name, billing address, credit card details including number and expiration date. The customer authorizes Golden Limousine to charge the credit card for agreed upon prices and any additional charges if the services exceed the authorized amount. The customer signs and dates the form to allow Golden Limousine to process credit card payments.

Uploaded by

Alexander Weir-Witmer
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

9/18/2020

AUTHORIZATION TO CHARGE CREDIT CARD

Name On Card: _______________________________________________________________

Billing Address: ____________________________________________________________

City ____________________________________ State _______ Zip ________________

Credit Provider: AMX MC Visa Disc Diners Other______________

Credit Card Number: _________________________________________________________

Expiration Date:______________________________ Security Code _______________


(4 digits on front of AMX)

Amount: $_____________________________

I authorize Golden Limousine, Inc. to debit my credit card for the charges for
their services rendered at agreed upon prices. Should services provided go over
the above authorization, the additional time and charges will be applied to the
customer’s credit card.

Signature ______________________________________________ Date _____________

INSTRUCTIONS
Please fill out form completely, printing or typing legibly. Sign, date and fax or e-mail back to
Golden Limousine at 734-668-0433 or billing@goldenlimo.com. Mail original to Golden
Limousine at the address included below.

Golden Limousine
11900 Carpenter Road
Milan MI 48160

FAX: 734-668-0433
PHONE: 734-668-8282

2002 LCT MAG Operator of the Year Finalist

11900 Carpenter Road Website - www.goldenlimo.com Phone 734-668-8282


Milan, MI 48160 E-mail – reservations@goldenlimo.com Fax 734-668-0433

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