Credit Card Authorization Form

Member first name:_________________________________

Last Name_________________________________________

Address where you receive your credit card bill.

Street:____________________________________________

Billing city: ________________________________________

State _________________________Zip Code_____________

Phone___________________ Cell __________________ Work ______________

Circle One: Visa ———– MasterCard ———- Amex———- Discover

Credit Card #_____________________________________Expiration Date: ____

$ AUTHORIZATION AMOUNT $________________________________________

Place a copy of front and back of credit card in the space below along with your picture identification (i.e your Driver License) and Fax Form to 972-840-1280.  I, the undersigned, hereby authorize Angel Limos. Dallas TX to automatically deduct payment from the credit card listed above to cover all charges incurred in relation with my transportation service on behalf of ________________________________ (passenger’s name).

Card member signature: ____________________________________ Date: __________