Credit Card Authorization Form for Transportation Services
Credit Card Payments - Visa, Master Card, American Express, and Discover are accepted and processed by Green Ride. To use your credit card, please,
1.  Fill in the blanks online
2.  Print out and sign this Form, authorizing the charge to your card account.
3.  Fax or email-scan this Form to the addresses shown below.
Fax: (888) 461-4825
Email: Creditcard@greenride.net
Credit Card Authorization Form:
 I authorize Green Ride to charge my credit card for Transportation services rendered. I understand that the charge reflected on my Credit Card
Statement will be in the name "Green Ride”  or "LIMAXI LLC". My authorized signature on this form will be valid for any future, ongoing charges
that I may choose to charge through Green Ride or LIMAXI LLC. My authorization information is as follows:
Exact name on card:
Type of card: 
Card number:
Expiration date:  
Credit card verification number What is this
Initial amount authorized:  US$   20% Driver's gratuity is extra
Billing zip code:
Your credit card billing address:
City/State/Zip:
Country:
Phone number:
E-mail:
Today's date:
Contact Phone Number:
Instructions:

   
Signature: X______________________________
   
   
   
 

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San Diego Transportation Referral