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CREDIT AUTHORIZATION

DCA Sedan Services

1.703.618.8712 ~ Fax: 000.000.0000 ~ DCA-sedan.com ~ info@dca-sedan.com The process of this application requires a Physical Signature. Please complete the entire application, print it, sign it and fax it to 000.000.0000

Today Date

M

D

Y

In Lieu on my credit card imprint, I On behalf of Inc. to charge the credit card listed below for services provided.

authorize DCA Sedan Services

Name of Card Holder Credit Card Billing Address

Street City

Card Type

State

Visa

Master Card

Discover

Zip Code American Express

Card Number Card Expiration Date

M

Y

(The last 3 digits On the back of your card)

Security Code Fax Number

Authorized Passenger By signing below, I acknowledge the charges listed on the DCA Sedan Service web site. In the event of passed cancellation deadline, I authorize DCA Sedan Service to charge the full reservation fee. I read and agreed to all the cancellation guidelines (terms and conditions) that apply to my reservation. I understand that I’m liable for any late fees, cancellation fees, taxes and other charges. I will not dispute this charge. Payment based on DCA Sedan Service rate listed on the web as card member’s agreement.

Client's Signature

Print Name

Date M

D

Y

Dca sedan credit aauthorization Form  
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