My Chauffeur Wine Tours
Corporate / Personal Credit Card Account FAX Submittal
1-877-692-4283; Local 503-969-4370; Fax 503-261-0816
You may set up a personal or corporate account at any time. The My Chauffeur Credit Card Account saves you time each time you arrange tour transportation, adds convenience and limits the exchange of sensitive information. Please print out and complete this form and fax it to 503-261-0816 or email to admin@tourportland.com. We will contact you within 48 hours to confirm. Once you set up an account, you may terminate it at any time. View our Privacy Policy.
Date__________________ PERSONAL
£ CORPORATE £COMPANY NAME: ___________________________________________________
PASSENGER(s): ____________________________________________________
__________________________________________________________________
CONTACT PERSON: _________________________________________________
OFFICE STREET ADDRESS: __________________________________________
__________________________________________________________________
CITY: ________________________ STATE: __________ ZIP CODE: ___________
OFFICE PHONE: __________________________ FAX: ______________________
HOME ADDRESS:
___________________________________________________________________
CITY: _________________________ STATE: __________ ZIP CODE: ___________
HOME PHONE: _______________________ ALT. PHONE: ____________________
CREDIT CARD NUMBER: _______________________________________________
EXP. DATE: _______________
CIRCLE CREDIT CARD TYPE: VISA MC DINERS CLUB AMEX
CARD HOLDER'S NAME: _______________________________________________
BILLING ADDRESS:____________________________________________________
____________________________________________________________________
Ü By signing below, I hereby authorize placing this card on file with My Chauffeur, and I understand that my card information will be on file with My Chauffeur and I may initiate payments to My Chauffeur using this card. I understand that My Chauffeur will charge my card at the termination of each reservation contract, or at “rides end”. I understand that if I should become past due on my My Chauffeur fees or my account suspended, My Chauffeur may charge my fees owed to this card. This authorization to perform charges to my card will remain in full force and effect until one of the following events: (i) the termination of my account with My Chauffeur, (ii) the expiration of my card, or (iii) the termination of this authorization, notified from me to My Chauffeur.
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PERMISSION TO CHARGE CREDIT CARD
AGREED AND ACCEPTED BY:
___________________________________________
SIGNATURE
TITLE: ___________________________________________
SPECIAL INSTRUCTIONS:
Thank You for your Order