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Romantic Remembrances Limousine Rental in Garland, TX

To Romantic Remembrances (RR) Limousine Service,

By affixing my signature below,

I (Print Name exactly as is on card):________________________________________,

do herby authorize Romantic Remembrances to charge my

(Visa, MC or AE) ________________________________

Credit card account # ___________________________________________ which expires on (Mo/Year) _______/_______ for any and all charges incurred for transportation services ordered by (Name) ______________________________ and provided for (Name) ____________________________________________.

I am fully aware that these charges will be billed to my credit card and understand that my signature below will serve the same as if I had actually signed the credit card voucher. I am also fully aware RR terms and cancellation policy and that my credit card will be charged the total cost of services ordered if not cancelled within 30 days of the service time requested (signature):

X___________________________________________ Date: _____________________

For Romantic Remembrances Limousine to be able to get authorization to charge this credit card with your signature the credit card company above will ask us to verify the following information:

Security code ID on card: ________________ (3 digits on MC, Visa and 4 digits on AE)

Billing Address: __________________________________________________________

City, State, ZIP: __________________________________________________________

Phone #: ____________________________ Business #: __________________________

Driver’s License # _________________________________________ State: __________

(If possible: please provide a photocopy of your driver’s license)

*** Please fill out and sign all of the above information and fax this form to

Romantic Remembrances Limousine FAX # at 972-485-9452 (Ref PMB #175)