Credit Card Authorization Form

Credit Card Authorization Details

Credit card details

Cardholder name

Card number

Expiration (mm/yy)

Security code

Cardholder info

Account type

Personal

Corporate/Company name

Issuing bank

Bank phone #

Charges must not exceed

Currency

Credit card holder address

Street number

Street

ZIP

City

State (optional)

Country

Card holder email

Card holder phone (optional)

Please, enter below the number of the reservation, PO number, or describe the service you are purchasing:

I, ******, authorize Limos4 GmbH to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.

(Please sign in the box above)

Credit Card Authorization Details

Credit card details

Cardholder info

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