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Executive Transportation
P.O. Box 612465
Miami, FL 33261

(877) 800-6500 ~ (718) 374-5066
Fax (917) 591-8290

Credit Card Authorization Form

Note: Please complete online, print, sign and either fax or scan & eMail.
Card holder’s first name:  Middle name:
Last name:
Company Name:  
Billing street address:  
Billing city:Billing State:Billing zip:
Contact name:Phone #:Extension:

Credit Card Details

Card type:
  Card #:
Exp date:

Sec Code (CVV):
 Choose CC authorization type
Place a copy of front and back of
credit card in the space below
or scan, take picture of front and back of card and send it via eMail (reply to your confirmation eMail)
I, the undersigned, hereby authorize Executive Transportation Inc., D/B/A to automatically deduct payment from the credit card listed above to cover all charges as follows:
a) Charges incurred in relation with my reservation(s) #
in behalf of
b) Keep on-file to satisfy charges incurred and billed to our corporate account:
Legal company name:
Card member signature:
__________________________________________  Date: _______________

Now create your username & password to access your concierge account.

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