Corporate credit card authorization form

Company/corporate name:
Auth member first name:	Middle	Last name:
Billing street address:
Billing city:	Billing state	Billing zip:
Billing contact name:	Phone #	Ext:
email:

Place a copy of front and back of credit card in the space below
PLACE COPY OF CARD FRONT HERE!!	PLACE COPY OF CARD BACK HERE!!
or scan front and back of card and send it by E-mail

I, the undersigned, hereby authorize Executive Transportation Inc., D/B/A AirportsPickup.com to automatically deduct payment from the credit card listed above for all charges incurred in relation with our corporate account _____________________.

· When paying with credit card, a $3.00 or 3.5% (whatever is higher) credit card processing surcharge will be added to total invoice amount.

Authorized card member signature: ___________________________ Date: ____________________

Please complete, print, sign and fax/mail it to Executive Transportation using the information above.


Corporate credit card info

CC Type: Card #	Exp	Sec digits

Corporate credit card info