PROOF OF PURCHASE AUTHORIZED

CUSTOMER DETAILS

* Indicates required field

First Name *

Phone Number *

Service Inquiry *

How Many Passengers *

Email *

Last Name *

Trip Type *

Service Date And Time *

Customer Verification

Upload Drivers License/ID helps us verify real customers *

Max file size: 20MB

Full Name of the card holder *

First

Last

Upload Head Shot of yourself helps verify real transactions *

Max file size: 20MB

I acknowledge that United taxi services only charge by debit and that me the customer is not present I the customer also acknowledge that I am making a service purchase online I grant permission to be debited the amount discussed with United taxi services *

Transaction Amount Discussed *

I the customer understand that there is no refunds for appointments or online purchases *

Card Holder Phone Number *

Card Holder Full Name *

First

Last

Customer Bank Name *

Bank Phone Number *

Customer service Needs

Customer Pickup Address *

Line 1

Line 2

City

State

Zip Code

Country

Customer Drop Off Address *

Line 1

Line 2

City

State

Zip Code

Country

Submit

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