Auth member first name:

Middle

 Last name:

Billing street address:

Billing city:

Contact name:

Credit card details

    Sec digits

PLACE COPY OF CARD FRONT HERE!!

PLACE COPY OF CARD BACK HERE!!

or scan front and back of card and send it by E-mail

I, the undersigned, hereby authorize Executive Transportation Inc., D/B/A AirportsPickup.com to automatically deduct payment from the credit card listed above to cover all charges incurred in relation with my reservation(s) #
in behalf of _______________________________________________________________________ (passenger's name).

·       A $3.00 or 3.50 % (whatever is higher) credit card processing surcharge  will be added to total fare amount as disclosed on confirmation.

Card member signature: __________________________________________  Date: _______________

Please complete, print, sign and fax/mail it to Executive Transportation using the information above.