Credit Card Form Name: Select Credit Card: Please Select One ----> Mastercard Visa American Express NAME OF COMPANY: NAME ON CREDIT CARD Experation Date CREDIT CARD'S VERIFICATION #: (please see example below ) E-Mail Home Number Cell Number: Billing Address City State Zip I hereby Authorize A&L Limousines, LLC, to charge my credit card. In the event that my credit card should decline for payment, I understand that I have to provide a new Credit Card and settle any past due balances. A copy of this Authorization is deemed as an original. Signature:______________________________________________________ Please print this form out and fax it to (516)797-6548. EXAMPLE OF VERIFICATION # FOR VISA & MASTERCARD We require that you enter your card's verification number. The verification number is a 3-digit number printed on the back of your card inside the signature box. EXAMPLE OF VERIFICATION # FOR AMERICAN EXPRESS We require that you enter your card's verification number. The American Express verification number is a small 4-digit number printed on the front of your card on the right hand side.