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CREDIT CARD AUTHORIZATION FORM.

Full Name on Card*

Card Number*

Email*

Expiration Date*

Street Address*

Address Line 2

City*

Country*

ZIP/Post Code*

State*

Cell Phone*

Phone Number Associated with Card*

Date of Ride*

Additional Phone*

Passenger Name*

Email*

A cancellation fee equal to the total trip cost including gratuity will be charged to the above credit card for any cancellation made less than 24 hours before the scheduled pickup time. Westchester County Limo cannot be held responsible for passenger flights or trains that are missed, canceled, diverted, delayed, or any other incident the company cannot control which results in failure by the customer to comply with the above-required cancellation policy. In these instances, we will exact our best effort to fulfill client needs, subject to wait for time fees or late cancellations and re-bookings, without detriment to other reserved clients. If for any reason the account balance is not paid, I agree that I will be liable for any and all reasonable legal fees and costs, in addition to my outstanding balance.

I, with this, authorize Westchester County Limo to debit my credit card in the amount listed below or any amounts pre-approved by me. I understand that the execution of this authorization constitutes such approval. I assume full responsibility for any and all non-payments. The cancellation policy has been fully explained to me and I understand the same. I understand that the below charges may change based on additional stops, parking, tolls, overtime, and other miscellaneous expenses. No further signatures will be required for such a credit card payment.

Terms & Conditions*

I accept Westchester County's terms & conditions

Your Signature*

State Issued ID*

Date of Signature*

Print Name*

Card Front*

Card Back*

For consultation

CREDIT CARD AUTHORIZATION FORM.

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