CREDIT CARD AUTHORIZATION FORM

VISA and Mastercard

Company Information
(If applicable)

Name

Office Phone

Website / URL

Account Administrator
(Not necessary the card holder)

Name *

First

Last

Cell Phone *

Email *

Add additional Authorized user

Upload prof of ID and Credit Card

Upload photo of Cardholder ID *

Click or drag a file to this area to upload.

.jpg and .pdf files only. Max 20 MB.

Upload photo of front of VISA or Mastercard *

Click or drag a file to this area to upload.

.jpg and .pdf files only. Max 20 MB.

Upload photo of back of VISA or Mastercard *

Click or drag a file to this area to upload.

.jpg and .pdf files only. Max 20 MB.

I authorize Panama Executive Transportation Corp. to charge the Credit Card stated in this form for all expenses related to reservations and used services made by the account administrator, I the cardholder or any user authorized by the account administrator, either stated in this form or later authorized users sent from the account administrators e-mail stated in this form to info@panamaexecutive.com

I accept terms and prices stated at time of service, found on www.panamaexecutive.com

I understand, and I have informed all authorized users, that if the driver can not be found at the agreed pick up location, it is the responsibility of the client to call Panama Executive Transportation at +507 261 44 44. Failure to call Panama Executive Transportation and leaving a pick up location will result in a no-show charge to the credit card.

As part of the approval process the card will be charged with 1 USD for confirmation purposes.

We are happy to help you with any special arrangements regarding your account or any questions you might have.

We will set up and confirm your account within 24 hours of receiving this form.

Date

Cardholder Signature *

Message