VILLAGE CAR SERVICE 
      "We Get Around"
718.761.3100    718.698.6900 
             




VILLAGE CAR SERVICE 
"We Get Around"
718.761.3100    718.698.6900 
Credit Card Authorization Form

Please use this form to reserve any 14 passenger van call, as well as all pick ups off Staten Island.
Terms and Conditions: Airport pickups are given 1-hour free wait time from the time the flight lands. Thereafter, wait time is prorated at $30.00/hr. All cancellations within 24 hours of pick up time are subject to forfeiture of deposit. Submitting this form does not charge your credit card.  We hold the authorization until the day and time of your pickup, at which time you can choose to either charge the card or pay cash.

First Name: *
Last Name: *
Phone: *
Email: *
Date of Travel: *
Pickup Time: *
Vehicle Type: *
How Many Ppl: *
Pickup Address: *
Pickup City, State, Zip: *
Destination: *
Destination City, State, Zip: *
PAYMENT INFORMATION:
Billing Address Street 1: *
Billing Address Street 2:
Billing City, State, Zip: *
Credit Card #: *
Exp Date: *
CVV2: *
Base Rate: *
Tolls:
Tip:
Total Charge Amount: *
 Terms and Conditions: * Please check the box and type your initials to acknowledge that you have read the above Terms and Conditions:
I hereby authorize Village Car Service to charge my credit card for the amount stated above: (Type full name) *
Special Instructions: