Authorization Payment Card Holder

Authorized payment Card Holder

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Customer Name *

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Last

Customer Email Address *

Bank Name *

Bank Phone Number *

CARD HOLDER Full NAME *

Type Of SERVICES *

Trip Type *

Pickup Address *

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Line 2

City

State

Zip Code

Country

Drop Off Address *

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Line 2

City

State

Zip Code

Country

Upload ID/Drivers License Helps Verify Real Rides *

Max file size: 20MB

I Agree to let united Taxi Services charge my bank for the services I am requesting I also agree to the price that I was quoted below I also acknowledge that I will pay for services by invoice *

Cancellation Policy I understand that all sales are final and that there are no refunds for cancelled orders on invoices or online payments or online appointments *

Customer Name *

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Last

Date of service *

Card Holder Name *

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Last

Date of services *

Transaction Amount quoted by United Taxi Services *

Tip Amount if any please enter a dollar amount *

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