Credit Card Authorization Form
Please fax back with :
1.Photo Copy of Credit Card
2. Photo Copy of Driver License
3. Fax Completed form to 201-585-2741

Customer Information:
Name _________________________________________

Street Address__________________________________

City________________________________________________

State______________ Zip________________

Phone#__________________ Fax#______________________

Credit Card Information:

Name on Card______________________________________

Card Number_______________________________________

Expiration Date_____________________________________

Circle One Visa Master card American express

CVV2 Code (3 digit code on back of Visa/Mastercard) ________

CID Code (4 digit code on front of American Express) _______

Billing Address On Credit Card____________________________
_____________________________________________

Driver License#____________________ State__________

_____________________________________________

To Whom it May Concern:
By this letter of facsimile, I am authorizing ABC towing to charge my credit card listed above for any charges incurred for services rendered.

Amount of Charges $_________________________

Authorized Signature______________________________

Print Name__________________________ Date____________