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CREDIT CARD CHARGE FORM
Please fax
this form to 615-250-0530
Type of
Credit Card: American Express □ Discover □
MasterCard □ Visa □
Credit
Card Number: ________________________________________
CVV Security Code (usually 3 or 4 digits on back of card): __________
Expiration
Date: ___________________________________________
Name on
Card: ____________________________________________
Cardholder's Billing Address:
Street:____________________________________________________
City:
_____________________ State: _________ Zip Code: ________
Phone:
___________________________________________________
Signature
of Cardholder: ____________________________________
Service(s) Ordered
(Airfare, VIP Service, Cell Phone, etc.)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
THANK YOU!
Total Amount
To Be Charged (USD): $__________
If you're ordering
AIRPORT VIP service and have not provided this information through our
on-line request form, please complete the following
Airline
__________ Flight Number ________________Flight Arrival
Time _____________
Arrival Date
___________________ City the flight is coming from
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