"Worthy of Trust and Confidence"

SIGNATURE ON FILE & CREDIT CARD BILLING AUTHORIZATION
1- (888) 553-0043     (818) 755-0044 Fax:
( 818) 755-0005
4400 Moorpark Way     Toluca Lake, Ca. 91602
"Servicing all of Southern California"

NAME OR 
COMPANY NAME IF CORPORATE CARD ____________________________________________________ 
BILLING ADDRESS: ______________________________________________________________________
                                     Billing address for credit card 
                                   
_____________________________________________________________________
HOME TELEPHONE: ________________________ BUSINESS TEL: _____________________________ 
                             FAX NUMBER: _____________________________
CREDIT CARD NUMBER: ____________________________________ Expiration Date__________ 
CREDIT CARD TYPE: ___________________                   Personal _____ Corporate Card _____ 
(AMEX / MASTER CARD / VISA / DISCOVER / DINERS CLUB)                           (CHECK ONE) 
NAME AS IT APPEARS ON CREDIT CARD: ___________________________________________________ 
                                                                                  (PLEASE PRINT) 
* THE FOLLOWING MUST BE COMPLETED BY THE CARDHOLDER FOR THE CREDIT CARD
INDICATED ABOVE AND SIGNED BY THE AUTHORIZED USER ONLY
"
ONE FORM PER SIGNATURE

I, _________________________________AUTHORIZE CITI LITES EXECUTIVE TRANSPORTATION, INC. TO PROCESS THE ABOVE CREDIT CARD AS "SIGNATURE ON FILE" FOR GROUND TRANSPORTATION SERVICES. 

                              Please list all persons authorized to charge services to this card:
1.NAME:________________________________________________PHONE:_______________________________ 
2.NAME:________________________________________________PHONE:_______________________________ 
3.NAME:________________________________________________PHONE:_______________________________

PLEASE INDICATE WHETHER SERVICES ARE FOR SINGLE OR MULTIPLE USE

CARDHOLDERS SIGNATURE: _____________________________________________ Date: ______________ 
FOR PRIVACY FAX TO 818-755-0005          REFERRED BY:_____________________________________________ 
                                                                                       INDIVIDUAL'S AND/OR COMPANY NAME "Optional"


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Thank You