My Chauffeur Transportation Co.

Toll-Free 1-877-692-4283;       Local 503-969-4370;      Fax 503-261-0816

Corporate / Personal Credit Card Account

On-line Submittal form

FAX submittal form

(Secure Form-SSL Encryption. The information is protected using the industry standard SSL )

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.  Our on-line submittal systems is secure. We will contact you within 48 hours to confirm.  You may review our Privacy Policy & Terms & Conditions.

Today's Date        

Reservation #: (if applicable)

PERSONAL        

CORPORATE COMPANY NAME:

PASSENGERS AUTHORIZED TO USE THIS ACCOUNT **:

1.

2.

3.

4.

Do not limit company passengers who may use this account.

** List passengers who may use this account.  Add additional passengers over 3 under Special Instructions below.  At least 1 passenger must be listed above.

CONTACT PERSON:

OFFICE STREET ADDRESS (Corporate Account): 

CITY: STATE: ZIP CODE:

OFFICE PHONE:   FAX:

HOME STREET ADDRESS (Personal Account):

CITY: STATE: ZIP CODE:

PHONE:

ALT. PHONE:

Your credit card information is secure

CREDIT CARD NUMBER *: No Spaces

EXP. DATE:          

CREDIT CARD TYPE:         VISA         MC       DINERS CLUB       AMEX

CARD HOLDER'S NAME: same as contact person

BILLING ADDRESS: same as contact person office address  same as contact person home address

PERMISSION TO CHARGE CREDIT CARD:

AGREED AND ACCEPTED BY:

                                

TYPED NAME

(A typed name is contractually and legally binding.)

COMPANY TITLE (IF APPLICABLE):

SPECIAL INSTRUCTIONS:        

 

* By AUTHORIZING AND AGREEING 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, notified from me to My Chauffeur.

Submitting this form is a request for a My Chauffeur Account.

Your request will be processed immediately.  A representative will contact with you within 24 hours to confirm.  Final confirmation is issued at that time.  Please contact us if you do not receive this confirmation within 24 hours (excluding Sunday).

Please confirm also by phone: Yes   No

Thank You for your Order

 

 

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