Credit Card Authorization Form

Credit Card Authorization Form
Credit Card Payments - Visa, Master Card, American Express, and Discover are accepted and processed by Green Ride. To use your credit card, please, 1. Fill in the blanks online 2. Print out and sign this Form, authorizing the charge to your card account. 3. Fax, mail, or email-scan this Form to the addresses shown below. Mailing Address: Green Ride, 2347 Salisbury Drive, San Diego, CA 92123-3839 Fax: 858-268-8247 Email: Creditcard@greenride.net Credit Card Authorization Form: I authorize Green Ride to charge my credit card for Transportation services rendered. I understand that the charge reflected on my Credit Card Statement will be in the name "Green Ride” or "LIMAXI LLC". My authorized signature on this form will be valid for any future, ongoing charges that I may choose to charge through Green Ride or LIMAXI LLC. My authorization information is as follows:
Exact name on card:
Type of card:
Card number:
Expiration date:		Comments:
Credit card verification number	What is this
Initial amount authorized :	US$ 20% Driver's gratuity is extra
Billing zip code:
Your credit card billing address:
City/State/Zip:
Country:
Phone number:
E-mail:
Today's date:

Signature:	X______________________________