| Limousine Services of Cape Cod |
| Cape Cod - Barnstable - Boston - Bristol - Marthas Vineyard - Nantucket - Plymouth - Providence, RI |
| Print and Fax this form to 508-896-4445 Credit Card Fax Form |
Reservation Date:
Passenger:
Customer:
The credit card is for the payment of the following:
Rate:
Gratuity:
Deposit:
Balance Due:
Damages:
Missing Glasses:
Excessive Cleaning:
Amount to be Charged to Credit Card:
Card Holder:
Card Holders Mailing Address:
Card Holders Mailing Zip Code:
Card Number:
Expiration Date:
CVV2 Code:
( 3 digit code on the back of the card, or for American Express Cards the 4 digit code on
the front)
Would you like us to add the additional time and gratuity to the card if the reservation
goes over the reserved time? Yes ______ No ______, I will be paying by cash or
another card.
Signature of Card Holder:
By signing and faxing this form, you are authorizing Limousine Services of Cape Cod, to
process your credit card for payment(s) as noted above.
Thank you.
Passenger:
Customer:
The credit card is for the payment of the following:
Rate:
Gratuity:
Deposit:
Balance Due:
Damages:
Missing Glasses:
Excessive Cleaning:
Amount to be Charged to Credit Card:
Card Holder:
Card Holders Mailing Address:
Card Holders Mailing Zip Code:
Card Number:
Expiration Date:
CVV2 Code:
( 3 digit code on the back of the card, or for American Express Cards the 4 digit code on
the front)
Would you like us to add the additional time and gratuity to the card if the reservation
goes over the reserved time? Yes ______ No ______, I will be paying by cash or
another card.
Signature of Card Holder:
By signing and faxing this form, you are authorizing Limousine Services of Cape Cod, to
process your credit card for payment(s) as noted above.
Thank you.
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