E-LIMO LA CREDIT CARD AUTHORIZATION FORM

Fax:310.737.0890




An authorization will be made on your credit card(s)at anytime for reservation, cancellation & damages:

You request that we use the credit card(s)to:

I ………………………………………………………………………………………………………………………………………………………………
Hereby authorize E-LIMO LA To charge the following credit card.
( please print clearly )

Name as it appears on credit card: …………………………………………………………

Type of credit card: ………………………………………… Expiration date: ……………/………………………

Today's date: ………………/……………………/……………………………

Credit Card# ………………………………………………………………………………………

Security Pin (3 digits back of card) #…………………………

Signature: …………………………………………………………………………………………………

Billing Address: ………………………………………………………………………………………………………………………………………………………………

City: …………………………………………………… State: ………………………… Zip Code: ………………………



For all charge card billing, it is necessary to have a credit card signature authorization form on file in our corporate office. Please complete the form and return it to E-LIMO LA.
You may indicate up to two credit cards and advise us each time you wish to use our services as to which card you would like to use. These cards will remain on file 1 month for your billing convenience. If at anytime you wish to terminate these arrangements, please submit such request in writing.

**By signing this form I understand that there are no refunds.


Your Comfort and Satisfaction Is Our Priority, Thank You For Your business.





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