E Mail Address:             

Confirmation Number:      Date of Service: 

Name (as it appears on credit card): 

Telephone numbers:

Home:   Work: ext:

Fax:        Cell:

CREDIT CARD INFORMATION

Check one: Visa    MasterCard    Diners    Discover    AMEX

Card Number:    Exp. Date: Security Code:

Billing Address (where credit card bill is sent):     

City:   State:   ZIP:  

PLEASE CHARGE CREDIT CARD AS FOLLOWS:

  I authorize Avery Limousine Global www.carservicesinct.com to charge the credit card specified above the full amount of the service.  In accordance with the terms and conditions between Avery Limousine and the undersigned, I fully understand Avery Limousine Global`s Cancellation Policy.  I authorize Avery Limousine Global to process all charges accordingly.

  I would like to establish a retail credit card account and authorize Avery Limousine Global to process any charges for all future service. I, the undersigned, authorize Avery Limousine Global to charge the above referenced credit card for transportation and related services which may be rendered through Avery Limousine Global and/or its affiliates.   In accordance with the terms and conditions between Avery Limousine Global and the undersigned, I fully understand Avery Limousine Global Cancellation Policy.  I authorize Avery Limousine Global to process all charges accordingly.

Please print Form then sign actual signature, date and fax.

Signature: ----------------------------------------------------------------        Date: ----------------------

            Name:    Phone #: