Credit Card Authorization Form

Credit Card Authorization Form for Transportation Services. Credit Card Payments - Visa, Master Card, American Express, and Discover are accepted and processed by GreenRide.net. To use your credit card, please.
1. Fill in the blanks online
2. Print out and sign this Form, authorizing the charge to your card account.
3. Fax or email-scan this Form to the addresses shown below. Fax: (888) 461-4825 Email: Creditcard@greenride.net
Credit Card Authorization Form:
I authorize GreenRide.net to charge my credit card for Transportation services rendered. I understand that the charge reflected on my Credit Card. Statement will be in the name "GreenRide.net” or "LIMAXI LLC". My authorized signature on this form will be valid for any future, ongoing charges that I may choose to charge through Green Ride or LIMAXI LLC. Furthermore, I authorize to be charged for waiting time charges if any, or any additional charges related to services rendered. My authorization information is as follows:
Exact name on card:                                                                                        Type of card:

Card number:                                                                                                    Expiration date:

Credit card verification number:                                                                    Initial amount authorized: US$
What is this                                                                            20% Driver's gratuity is extra
Your credit card billing address:

Billing zip code:                  City/State/Zip: Credit Card Billing                           Billing Phone Number:

E-mail:

Today's date:                                                                                                     Contact Phone Number:

Instructions:

Signature: X______________________________