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Credit Card Authorization Form
Please print and complete this form, then fax to 444-Taxi, Inc at 281-821-1244. Highlight and print the entire form and sign with the credit card holder's signature on the line indicated. Include a photocopy of the front and back of the signed credit card. OR scan and email the completed form and the photocopies of the credit card to complete your order. |
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I hereby authorize 444-TAXI, Inc. to charge my VISA, MasterCard, Diners Club, Discover or American Express account:
Card number _______________________________________________________________ *
*You must include in your fax a copy of the front and back of your credit card.
Expiration Date: ________________________________________________________
Cardholder Name: ________________________________________________________
Cardholder Signature: ________________________________________________________
Billing Address: ________________________________________________________
City, State, Zip: ________________________________________________________
Home Phone # ________________________________________________________
Issuing Bank: ________________________________________________________
For verification and your own protection, please attach a copy of the front and back of your credit card. Your order will not be processed unless these copies are included in your fax. Thank you. |
