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Northmoor Limousine

  
  1. Complete the form online and type all billing  information in the blanks below, or print the form and complete the blanks legibly with a dark pen.
  2. Print the entire form and sign with the credit card holder's signature on the line indicated.
  3. Include a photocopy of the front and back of the signed credit card.
  4. FAX (1-303-344-5607) or scan and email the completed form and the photocopies of the credit card to complete your order.

Credit Card Authorization Form

I, , hereby authorize Northmoor Limousine LLC

To charge my credit card account in the amount of $  

including 20% Gratuity to the driver.
         
  VISA MasterCard American Express Discover Diners Club
 
Credit Card Number:                           

Expiration Date:  /            VID Code: 

Credit Card Billing Address:

Street:   
    City:      State:            Zip Code:  -      Telephone:  () -  

                                                                          Country: (if not US)  

As the credit card holder, I hereby acknowledge receipt of service.

__________________________________ ____/____/______
Cardholder's Signature Date

Your completion of this authorization form helps us to protect you, our valued customers, from credit card fraud.  All information entered on this form will be kept strictly confidential by Northmoor Limousine.