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Credit Authorization Form
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Contact Information
Full Name:
*
Phone Number:
*
Email:
*
Email (Confirm):
*
Transportation Service Information
Type of Service:
*
Click to Select
Airport
Corporate
Special/Package
Hourly
Charter
Wedding
Leisure
Please Select Your Vehicle Type:
*
Click to Select
Luxury Sedan
6 Passenger Limousine
8 Passenger Limousine
10 Passenger Limousine
12 Passenger Limousine
6 Passenger SUV
6 Passenger Luxury SUV
6 Passenger VAN
10 Passenger SUV
12 Passenger SUV Limousine
14 Passenger SUV Limousine
16 Passenger SUV Limousine
18 Passenger SUV Limousine
20 Passenger SUV Limousine
Total Hours:
*
Pick Up Info
Address:
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City:
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State:
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Select a State
New York
New Jersey
Connecticut
Other
Number Of Passengers:
*
Date:
*
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Time:
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AM
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Destination
Address:
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City:
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State:
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New York
New Jersey
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Drop-Off Instructions:
Airport Service Information
Airport:
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Flight Number:
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Service Options:
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Select option
Meet & Greet
Curbside
Payment Information
Credit Card:
*
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Visa
Master Card
American Express
Discover
Credit Card #:
*
Expiration Date:
*
MM/YY
Card Security Code:
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Name Of Cardholder:
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Billing Address:
*
Comments:
HOWDID YOU
LEARN ABOUT
OUR WEBSITE:
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Yahoo
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Business Associate
Family / Friend
I understand that deposits are not refundable due to client cancellation, and authorize NY TOP LIMO
to process charges to my credit card for rental service, overtime & any damages that might be incurred to the limousine by my guests or myself. I the customer take full responsibility and hereby waive any and all claims
against NY TOP LIMO.
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