Credit Authorization
Transcription
Credit Authorization
Chicago Interstate Limo CREDIT AUTHORIZATION www.chicagoilimo.com ~ Email: [email protected] ~ Phone: (847) 529-1233 ~ Phone: (312) 513-8063 ~ Fax: (224) 356-0562 The process of this application requires a Physical Signature. Please complete the entire application, print it, sign it and send it to us at your earliest convenience Today Date M D Y In Lieu on my credit card imprint, I On behalf of Inc. to charge the credit card listed below for services provided. Chicago Interstate Limo LLC Name of Card Holder Credit Card Billing Address Street City Card Type Zip Code State Visa Master Card Discover American Express Card Number Card Expiration Date M Y (The last 3 digits On the back of your card) Security Code Home / Office Phone Number Fax Number Authorized Passenger By signing below, I acknowledge the charges processed for transportation services by Chicago Interstate Limo LLC. In the event of passed cancellation deadline, I authorize Chicago Interstate Limo LLC to charge the full reservation fee. I read and agreed to all the cancellation guidelines (terms and conditions) that apply to my reservation. I understand that I’m liable for any late fees, cancellation fees, taxes and other charges. I will not dispute this charge. Payment based on Chicago Interstate Limo LLC rate listed on the web as well as other authorized charges is made to be in accordance with the issuing card policies. I affirm my obligations under the card member’s agreement. All Reservations Are Final, No Refunds Upon Cancellation Client's Signature Print Name Date M D Y
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