YARD LIMO LLC
232 BOULEVARD HASBROUCK HEIGHTS NJ 07604
Tel: 201-660-4365 – Fax: 973-741-5656
limoyard@hotmail.com
CORPORATE BILLING CREDIT CARD
AUTHORIZATION FORM
Please fill this “Credit Card Authorization Form.”
This will provide authorization to charge transportation service expenses to
the credit card listed below. Please return this form to us by fax or E-mail to
the number listed along with a copy of
the front and back of your credit card. This form needs to be submitted by
the initial date of service.
COMPANY NAME:
_________________________________________________________________
REPRESENTATIVE NAME:
____________________________________________________________
COMPANY EMAIL: _________________________________________________________________
TYPE OF CREDIT CARD:
______________________________________
CREDIT CARD NUMBER:
_____________________________________________________________
EXP. DATE: ____________________ SECURITY
CODE: _____________________
CARD HOLDER NAME:
______________________________________________________________
CARD BILLING ADDRESS:
_____________________________________________________________
CITY:
____________________________STATE________________ZIPCODE____________________
BUSINESS PHONE NUMBER (INCLUDING
EXT.):_________________________________________
BUSINESS FAX NUMBER:
_________________________________________
I the undersigned authorize Access Yard Limo LLC to charge the above referenced credit card for
transportation and related services. I understand that if trip is not cancelled
24 hours prior to scheduled pick-up time or if passenger does not show up for
the confirmed reservation, I will be charged the full amount of the trip. I
have read and agree to abide by the terms of this agreement and I am authorized
to act as an agent /representative for the above-named company and will be held
responsible for payment of transportation services charged to this account.
Authorized Cardholder/Authorized Representative
Siganature/Date:_______________________________________________________________
Print Name /
Title:______________________________________________________________
