Executiveride

info@executiveride.com

Toll Free : 1-877-455-9222

VA : 703-455-9222

DC : 202-410-3909

Maryland : 301-438-7505

Executive Ride Sedan & Limousines Services Inc.
7316 Spring View Court Springfield, VA 22153

Credit Card Authorization

Card Holder’s Name:

Company Name:

Card Number:

Exp:

CVV Code:

(4 digits located on front for Amex and 3 digits on back for Visa & Master Card)

Circle one:

Billing Address:

Suite:

City:

State:

Zip:

Billing Phone:

Email Address:

Authorized To:

Phone:

Email Address:

Amount:$

I hereby authorize Executive Ride Sedan and Limousine Services to charge my credit card account the original amount stated above.
I also authorize any additional charges incurred for the order number(s), for example, over time, toll and the processing fee to also be
charged to my credit card per my signed contract(s) with Executive Ride.

Cardholder’s Signature:

Date:

** Please fill out all the information, sign and date it and email back to info@executiveride.com ** Also include a copy of your credit card (both sides) and a copy of your driver’s license too.

** If you fail to provide the above information, your job may be hindered and you will be held responsible for all charges