Phone: 407 982 9772 Fax To: 407 905 0292

CASH SALES / TELEPHONE / FAX - CREDIT CARD AUTHORIZATION

CUSTOMER NAME: PHONE: FAX:

I AUTHORIZE EXECUTIVE TRANSPORTATION GROUP TO CHARGE THIS
CREDIT CARD, AND/OR ANY OTHER CREDIT CARDS I PROVIDE THEM.

CUSTOMER EVENT:     OUR ORDER#:


CREDIT CARD INFORMATION & BILLING ADDRESS
(As it appears on your credit card statement)

TYPE: VISA     MASTERCARD     CARD NUMBER EXP DATE:     CODE: NAME ON CARD
TODAYS DATE	ADDRESS City, State ZIP

CARD HOLDER - PRINT FORM, THEN SIGN THIS BOX BELOW
CARD HOLDERS Signature Here