Credit Card Authorisation Form

Credit Card Authorisation Form
Credit Card holder: _________________________________________________________
Phone: _______________________________
Fax: ___________________________
Address: __________________________________________________________________
Country: __________________________________________________________________
Email:
__________________________________________________________________
Billing Address:
___________________________________________________________
___________________________________________________________
O VISA
O AMEX
O MASTER
Card Number: _____________________________________________________________
Issue Date: ____________________________ Exp. Date: ________________________
Last 3 check-digits ____ ____ ____
(Visa or Master Card)
Last 4 check-digits ____ ____ ____ ____
(American Express)
Total Amount: ______________________________________________________________
(Add. unforeseen expenses (add. hours, road tolls, entrance fees and so on).
Lischka Limos & Co KG is authorised to charge this Credit Card.
Location:
____________________________
Date: ____________________________
Card’s holder signature: _____________________________________________________
Please send us this form by e-mail: [email protected] or by fax +49 711 2 85 88 58.
Please note: In case of payment by credit card we charge a fee of 3,5 % of the total amount.
Lischka Limos & Co. KG | Limousinen- und Chauffeurservice | Hackstrasse 156 | D-70190 Stuttgart
Geschäftsführer: Bernd Lischka | Betriebsführung: Brigitte Rieger | HRA 720232 | RG Stuttgart
Telefon: +49 711 2 85 88 48 | Fax: +49 711 2 85 88 58 | Mail: [email protected] | Web: www.limos4u.de