Please fax this form to 615-250-0530

 

Type of Credit Card: American Express □ Discover □ MasterCard □ Visa □

 

Credit Card Number: ________________________________________

 

CVV Security Code (usually 3 or 4 digits on back of card): __________

 

Expiration Date: ___________________________________________

 

Name on Card: ____________________________________________

 

Cardholder's Billing Address:

Street:____________________________________________________

 

City: _____________________ State: _________ Zip Code: ________

 

Phone: ___________________________________________________

 

Signature of Cardholder (Required): _________________________________

 

Service(s) Ordered (Entertainment, Airfare, VIP Service, Cell Phone, etc.)

_______________________________________________________________

 

_______________________________________________________________

 

_______________________________________________________________

 

THANK YOU!

 

Total Amount To Be Charged (USD): $__________

 

 

 

If you're ordering AIRPORT VIP service and have not provided this information through our on-line request form, please complete the following...

 

Airline __________ Flight Number ________________Flight Arrival Time _____________

 

Arrival Date ___________________ City the flight is coming from ___________________

 

Telephone: 615-566-9085            Email: travel@rowlandent.com             Fax: 615-250-0530

CREDIT CARD AUTHORIZATION FORM

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