Credit Card Authorization Form

Confirmation # or Invoice #(*)

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Phone(*)

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E-mail(*)

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Billing Contact Name(*)

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Billing Phone(*)

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Billing Address(*)

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City(*)

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State(*)

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Zip(*)

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Credit Card Information

Credit Card Type(*)

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Name of Cardholder(*)

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(as it appears on the card)

Credit Card Number(*)

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Expiration Date(*)

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Month/Year

3 Digit Security Code(*)

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Amount to be charged ($)(*)

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Agreement(*)

By checking this box, I authorize Luxury Transportation Group to charge my credit card upon completion of scheduled transportation. I certify that I am the authorized card holder of record, and that I have full authority to make purchases on behalf of the account listed above. I understand that cancellations must be made at least 24 hours in advance to reservation time.

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Captcha

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Credit Card Authorization Form

Credit Card Information

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