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INDIVIDUAL AND BUSINESS ACCOUNTS

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CORPORATE ACCOUNTS

 

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AUTOMATIC DEDUCTIONS

 

DEDUCTIBLE EXPENSES

 

 

SECURE TRANSACTIONS

CREDIT CARD AUTHORIZATION

JR TAXI accepts payment from all major credit card companies. To pay your fare using a credit card, simply complete and sign this form and attach a copy of the front and back of your credit card if possible. Signature and billing address must match authorized credit card holder for transaction to be processed successfully.

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APPLICANT’S INFORMATION


Please enter name of person or company authorizing this payment.

Title: Last Name: First  Name: M.I.:I.:
   
Account: Company Name:   ID Number
Personal
Corporate

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CREDIT CARD INFORMATION


Name as it appears on card: Credit Card Number: Expiration Date:
  -   -   -     /   /  
Visa Master Card Discover American Express Diner's Club CVC Code:
  -
Building No. Street, Apt City State Zip Code

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TERMS OF ACCEPTANCE


The applicant authorizes JR Taxi Service, LLC to charge credit card in the amount of $ (total) for taxi service provided on   //  /   (date of service)
 
Please select one:
I am authorizing the use of my credit card for a one time charge only.
I would like this credit card to be my payment method for future transactions and/or invoices.
 
* I understand that checking one of the above boxes constitute a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
* If you prefer, you can print and complete this form and handle it to a driver, or fax it to 1 (888) 211-3725.
 

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ELECTRONIC SIGNATURE

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I, the applicant for this authoirization form, warrant the truthfulness of the information provided in this application.
Please type your First and Last Name: Email: Date:
  /   /  

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DOWNLOAD FORM IN .DOCX OR .PDF FORMAT


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