CREDIT CARD AUTHORIZATION FORM
PLEASE PRINT OUT AND COMPLETE THIS AUTHORIZATION AND RETURN IT TO OUR OFFICE BY EMAIL OR BY REGULAR MAIL
Cardholder Name: ________________________
Signature:_____________________________
Address: _____________________________________________________________________
_____________________________________________________________________
Credit Card Type: ______ VISA ______ MASTERCARD ______
AMEX______
Credit Card Number: ________ - ________ - ________ - _________
Expiration Date:
________ / ________
Billing Zip Code: ________
Card Identification Number (last 3 digits on the back of the credit card):
________
Amount To Be Charged: $ _____________ (USD)
If other than the total amount due, please let us know what this amount applies
to
______
(Non-refundable
Deposit
)
______ (Other: ____________________ )
Email or mail the authorization using the information below:
Shoreline Livery LLC
PO BOX 681
Clinton, CT 06413