Credit Card Account

My Chauffeur Transportation Co.

Corporate / Personal Credit Card Account

On-line Submittal form

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 transportation, adds convenience and limits the exchange of sensitive information. Our on-line submittal system is secure. After submittal, we will contact you within 48 hours to confirm. Join our team with a corporate or personal account and receive an annual complementary wine tour on us, please inquire about details. You may review our Privacy Policy & Terms & Conditions. (NOTE: We do not offer 'billing accounts' unless you are a local company. Once we have a standing relationship, then we can set up a 'billed account' on request)

Toll-Free 1-877-692-4283 | Local 503-969-4370 | Fax 503-261-0816

Today's Date

Reservation #: (if applicable)

PERSONAL

CORPORATE / Company Name:

= required data

APPLICANT NAME:
COMPANY TITLE:
HOME OR OFFICE STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
PHONE:
EMAIL:
ALT. PHJONE:
OFFICE PHONE:
FAX:

PERSON(S) AUTHORIZED TO ORDER & USE THIS ACCOUNT AS PASSENGERS:

* List passengers who may use this account. Include Applicant above. Add additional passengers over 4 under Special Instructions below.

Do not limit company passengers who may use this account.

Additional persons go in COMMENTS box below.

Your credit card information is secure. To view our PCI DSS Compliance certificate, click here.

Credit Card Info:
Contact us at 503-969-4370 or toll-free 877-692-4283) to give us your credit card info. Or you may leave your phone # here (phone # same as above) and we will contact you. After we contact you and receive this info, we will then confirm your reservation. Please continue with sections below.

You may choose to save your CC info on-file and/or fill in the CC billing info below, if desired.

Save Credit Card # on file:
save this credit card & billing info. on-file ** If box is checked, after we receive your CC info, for convenience, we will save it on-file to be used for future reservations.

Enter your Credit Card Billing Info: Billing address is the same as info above, section 2.

Name on Card:

Street or P.O. Box:

City:

State:

Zip Code:

Country U.S.A.

I will be paying final bill by: Credit Card Debit Card Cash Undecided

** *** Billing Terms & Conditions

PERMISSION TO CHARGE CREDIT CARD:

AGREED AND ACCEPTED BY:

TYPED SIGNATURE

(A typed name is contractually and legally binding.)

COMMENTS/SPECIAL INSTRUCTIONS:

* By AUTHORIZING AND AGREEING below, I hereby authorize placing this credit card on file with My Chauffeur to be used on any future My Chauffeur reservations. 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 via the terminate account page on our website. Corporate/Private Rate Plan (if applicable) is non-refundable and may be cancelled by either party with no notice at any time.

Submitting this form is a request for a My Chauffeur CC account.

Your request will be processed immediately. A representative will contact with you within 24 hours to confirm. Final confirmation is issued at that time. Please contact us if you do not receive this confirmation within 24 hours (excluding Sunday).

Please confirm also by phone: Yes No

Thank You for your Order

Security Notice: This form features secure SSL technology.

TEL: 503-969-4370

Toll-Free: 1-877-692-4283

24/7 Service - My Chauffeur Office Hours

503-969-4370 | 877-692-4283

(intnl: +1.503.969.4370)

Monday - Friday

7am - 8pm

Saturday

8am - 6pm

Sunday

closed