In Lieu of my Credit Card Imprint,

I ___________________________________(Name of Credit Card Holder as shown on Credit card)

hereby authorize ORANGE TRANSPORTATION to charge my credit card.

Credit Card Holder’s Name: _____________________________________________

Credit Card # : __________________________________________ Exp Date : ____________

Total Amount : $ ____________________+Tolls, airport and port fees : $_____________

+ 20%(Driver’s Gratuity) _______________Total Charged : $ _____________

The charge is for payment of transportation for myself and passenger’s if other than card holder.

Passenger Name : ____________________________________ Number Of Passengers: _________

Date/Time: _________/__________

Pick-up Location: ____________________________ Drop-off Location ____________________________

(Please Circle As Applicable)

Type of Vehicle : Sedan - Limousine - Van - Bus Type of Service : One-way - Roundtrip - Charter

(Roundtrip Only) Date/Time: _________/__________

Pick-up Location: ____________________________Drop-off Location ____________________________

Cardholder Billing Address:____________________________________________

Home Phone#:______________ Work Phone#:___________Fax#:_________________Cell#:_______________

By signing below, I acknowledge charges described hereon.Payment in full to be made when billed or in extended payments in accordance with standard policy of company issuing credit card.

_____________________________________________________ Date:________________
(Signature of Card Holder)

Thank you for your business and your prompt action is appreciated.
Please fill out this form completely and fax it back to us @ 407-2263278

Travel Agents Only:

Referral By: ________________________________Business Name & Address: _____________________________

Business Phone # : _________________________________________________