Carrier Towncar,Inc
11866 Old Glory Drive 
Orlando, Fl 32837
Phone: 407-812-8989
Fax: 407-854-9861
Toll-Free: 1-866-407-1515
www.carriertowncar.com

Towncar Sedans   -   Stretch Limousines   -   Luxury Vans   -   Mini-Buses

CREDIT CARD HOLDER’S AUTHORIZATION FORM: 

In Lieu of my Credit Card Imprint, I _______________________________________(Name of Credit Card Holder as shown on Credit card) hereby authorize Carrier Towncar, Inc to charge my credit card. 

Credit Card Holder’s Name: _____________________________________________

Credit Card # : _________________________________ Exp Date : ____________

Total Amount : $ ___________ + 20%(Driver’s Gratuity) = $ ___________

Total Charged : $ __________

The charge is for payment of transportation for myself and passenger’s if other than card holder.

Passenger Name : ____________________________________ Number Of Passengers: _________

Date/Time: _________/__________ Pick-up Location: __________________________

Drop-off Location ____________________________

(Please Circle As Applicable)

Type of Vehicle :  Towncar Sedan  -  Stretch Limousine  -  Luxury Van  -  Mini-Bus

Type of Service :  One-way   -   Roundtrip   -   Charter

Cardholder Billing Address:____________________________________________

_________________________________________________________________

Home Phone#:____________________ Work Phone#:_____________________

Fax#:___________________________ Cell#:____________________________

By signing below, I acknowledge charges described hereon. Payment in full to be made when billed or in extended payments in accordance with standard policy of company issuing credit card.

Date:________________       __________________________________________

                                                                  (Signature of Card Holder)

Thank you for your business and your prompt action is appreciated. Please fill out this form completely and fax it back to us @ 407-854-9861

__________________________________________________________________________________

Travel Agents Only:

Referral By: ______________________________________________________

Business Name & Address: ___________________________________________

_________________________________________________________________

Business Phone # : _________________________________________________