Authorization Form

C I T Y L I N E L I M 0 U S I N E Corp.
Phone: 718.205.4254 Fax: 718.205.7002
CREDIT CARD CHARGE AUTHORIZATION FORM
In order for us to process your request,
please fill out, then print out, Sign, and fax back to us the foIlowing authorization to 718.205.7002.

I, (Cardholder name*)
Authorize " Cityline Limousine" to charge all expenses to my credit card:
Amex MC Visa Dinners OTHER
Card Number* # Exp.date* / V -code*

*Billing Address
* City * State *Zip code
*Home phone# Cell phone# Fax number#
E-mail

PASSENGER NAME*:
PICK UP DATE*: (Month/Day/Year) TIME*: AM PM
PICK-UP LOCATION*:
AIRLINE: FLIGHT#:
ARRIVAL TIME: AM PM or DEPARTURE TIME: AM PM
DESTINATION:
PASSENGER PHONE# PASSENGER CONTACT

Choose Vehical Type:
STRETCH SUPER STRETCH SEDAN MINI-VAN VAN
SURBURBAN BUS BENZ OTHER

NUMBER OF PASSENGERS:

I understand that these charges may include but are not limited to all tolls, parking, waiting time, stops, NO SHOW, LATE CANCELLATIONS etc.. If I can't find my driver, I understand that it's my responsibility to call " Cityline Limousine" . Failure to call our office and leaving pickup-location will result in No-Show charge to my credit card, I agree that if I wish to cancel my reservation it is my responsibility to notify " Cityline Limousine" at least (24) hours before reservation time. Failure to do so will result in LATE CANCELLATION charges to my credit card.
*Cardholder signature: _________________________________________ Date:______ /____ /__________

Please attach to this form a clear and readable photocopy of your credit card (both-sides).
Fax to 1.718.205.7002 We Thank you for choosing " Cityline Limousine"

Note: Please include your contact information with any and all E-mails.
Name, phone number, and dates when possible. Thank you.

Email Us: Services@CityLineLimo.com

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