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My Chauffeur Transportation Co.

Corporate/ Personal Credit Card Account Submittal form

Local 503-969-4370    /    Fax 503-261-0816

You may set up a personal or corporate account at any time.  The My Chauffeur Credit Card Account saves you time each time you arrange transportation, adds convenience and limits the exchange of sensitive information.   Please print out and complete this form and fax it to 503-261-0816.  Our FAX system is secure. We will contact you within 48 hours to confirm.  Join our team with a corporate or personal account.  You may review our Privacy Policy & Terms & Conditions.

 Date__________________           £ PERSONAL           £ CORPORATE 

 (Corporate Account)

NAME: __________________________________________

COMPANY NAME: __________________________________________

PASSENGER(S) AUTHORIZED TO USE THIS ACCOUNT: 

Do not limit company passengers who may use this account.

  1. _________________________________________________________

  2. _________________________________________________________

  3. _________________________________________________________

  4. _________________________________________________________

CONTACT PERSON: ________________________________________

OFFICE STREET ADDRESS (Corporate Account):

_________________________________________________________

CITY: ___________________________________ STATE: __________

ZIP CODE: ___________

OFFICE PHONE: ____________________ FAX: ___________________

 (Personal Account)

NAME: __________________________________________

HOME STREET ADDRESS (Personal Account):

__________________________________________________________

CITY: ____________________________________ STATE: __________

ZIP CODE: ___________

HOME PHONE: __________________________________

ALT. PHONE: ____________________________________


CREDIT CARD NUMBER*: _________________________________________

EXP. DATE: _____________

CIRCLE CREDIT CARD TYPE:      VISA       MC       DINERS CLUB       AMEX

CARD HOLDER'S NAME: _________________________________________

BILLING ADDRESS (INCLUDING ZIP CODE):______________________________________________

 ______________________________________________________________

*By signing below, I hereby authorize placing this credit card on file with My Chauffeur, and I understand that my card information will be on file with My Chauffeur and I may initiate payments to My Chauffeur using this card.  I understand that My Chauffeur will charge my card at the termination of each reservation contract, or at “rides end”.  I understand that if I should become past due on my My Chauffeur fees or my account suspended, My Chauffeur may charge my fees owed to this card.  This authorization to perform charges to my card will remain in full force and effect until one of the following events: (i) the termination of my account with My Chauffeur, (ii) the expiration of my card, or (iii) the termination of this authorization (http://www.portlandairporter.com/terminating_cc_account.htm), notified from me to My Chauffeur. Corporate/Private Rate Plan (if applicable) is non-refundable and may be cancelled by either party with no notice at any time.

PERMISSION TO CHARGE CREDIT CARD

AGREED AND ACCEPTED BY: ___________________________________________

                                                                             SIGNATURE

PRINT NAME: _________________________________________

TITLE: ___________________________________________

SPECIAL INSTRUCTIONS: