Credit Card Authorization Form for Transportation Services.

Credit Card Payments - Visa, Master Card, American Express, and Discover are accepted and processed by

To use your credit card, please,

Fill in the blanks online
Print out and sign this Form, authorizing the charge to your card account.
Fax or email-scan this Form to the addresses shown below.
Fax: (888) 461-4825  Email:

Credit Card Authorization Form:
I authorize 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". 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. Furthermore, I authorize to be charged for waiting time charges if any, or any additional charges related to services rendered. My authorization information is as follows:

Card number: 
Company name:
Expiration date:
Type of card:
Exact name on card:
Verification number: What is this
Initial amount authorized: 20% Driver's gratuity is extra
Contact Phone Number:
Billing Phone Number:
Credit card billing address:
Billing zip code: 
Today's date:
Signature: X______________________________