Card Number

Name on Card

Type of Card

Expiration Date

Phone Number

 E-mail Address

 

     I _______________________________ (Name)

     Authorize Aloha Limousine to charge my credit card for    services rendered on  __________________________ (Date)   and any excess charges that may occur as a waiting time, extra stops, or detainment of the limousine / cell phone uses or any damage to the limousine.

     _________________________________________ (Signature)

________________________________  (Date)

 * Must be card holder

Please Print the form, fill it out and Fax it to 1-630-694-8807

* Please call for your Confirmation number. 1-847-888-4117