Credit Card Authorization Form

CARDHOLDER INFORMATION(Required)

First Last

Billing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Direct Telephone(Required)

Email(Required)

Credit Card Type(Required)

Visa	Master Card	American Express	Discover Card

Credit Card Number(Required)

I hereby affirm that I am the owner of the below referenced credit card and that my name is listed on the front of the credit card

Expiration Date(Required)

Security Code(Required)

Billing Zip Code(Required)

Conf#. Please enter your reservation confirmation number you received in the email. You can also find this # in your email subject line.(Required)

Please enter your Conf#

I hereby authorize Limo in Miami LLC of Miami to charge my credit card (listed above) in the dollar amount of(Required)

Please enter the dollar amount of your transaction

Today's Date(Required)

Note (optional)

Signature(Required)

ID and Credit Card Photos Upload (Required for charges over $300)

Drop files here or

Max. file size: 2 MB.