Credit Card Authorization
Cardholder's Name
Contact Phone #
Fax #
Email
Billing address
(For the credit card)
Name As It Appears On The Card
Type Of Credit Card
Visa
Master Card
Discover
American express
Credit Card Number
Expiration Date
Card Verification # (3 numbers on the back of the card)
(AMEX Only 4 numbers on front of card)
By typing yes in the box below you are authorizing Roger's Livery Service to charge the above card for services rendered by RLS or its affiliates or charge any waiting time as stated at
www.rogerslivery.com
Type Yes
What This Authorization Is For
A Particular Reservation
Group of Reservations
Establish an Account With RLS
Other
If Someone Other than the Card Holder Should Be Contacted Regarding This Authorization, Please Place Your Name & Contact Information Here
Please place anything needed to know about this authorization
Indicates Response Required
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