My Chauffeur Transportation & Tour Co.

Corporate / Personal Credit Card Account - FAX Form

ON-LINE SUBMITTAL FORM

Toll-Free 1-877-692-4283     /     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 or email to admin@tourportland.com.  Above, an on-line submittal form is available.  Our FAX and e-mail systems are secure. We will contact you within 48 hours to confirm.  You may review our Privacy Policy & Terms & Conditions.

 Date__________________            PERSONAL £           CORPORATE £

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: ___________________

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:______________________________________________

 ______________________________________________________________

Ü 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, 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:         

                                           

Thank You for your Order