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This page is designed for the purpose of having our clients, when requested, send us their credit card information securely. The client that is requested to fill in the information below will not have their credit card charged online, all credit cards will be charged off-line after the services have been offered. Please fill in all fields and accept all terms and conditions found at the bottom of the page.

Please fill out the Credit Card Authorization form below:

CREDIT CARD HOLDER INFORMATION

NAME ON CREDIT CARD *
TYPE OF CREDIT CARD * VisaMastercardAmerican ExpressDiscoverOther
CARD NUMBER *
EXP. DATE *
CVV *
BILLING ADDRESS *
BILLING ADDRESS #2
CITY *
PROVINCE/STATE *
POSTAL/ZIP CODE *
PHONE *

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FRONT VIEW *
BACK VIEW *

AUTHORIZED USER OF CREDIT CARD

NAME *
COMPANY, if applicable
PHONE NUMBER *
EMAIL ADDRESS *
OTHER PHONE NUMBER
RELATION TO C. C. OWNER *
TYPE OF CHARGES/SERVICES *
PLACE OF CHARGES *
DATE(S) OF CHARGES/SERVICES *

AUTHORIZATION OF CARD USE

I certify that I am the authorized holder and signer of the credit card reference above. I certify that all information above is complete and accurate. I hereby authorize collection of payment by BLACK CAR LIMOUSINE for all charges related to services as indicated above.

(416) 224-8166

3555 Don Mills Rd, Suite 18-141.

Secure Link

Secure Link

Please fill out the Credit Card Authorization form below:

CREDIT CARD HOLDER INFORMATION

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AUTHORIZED USER OF CREDIT CARD

AUTHORIZATION OF CARD USE

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(416) 224-8166