My Chauffeur Wine Tours

Corporate / Personal Credit Card Account FAX Submittal

ON-LINE SUBMITTAL FORM

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.


PERMISSION TO CHARGE CREDIT CARD

AGREED AND ACCEPTED BY:

 ___________________________________________

                                SIGNATURE

TITLE: ___________________________________________

SPECIAL INSTRUCTIONS:                                                           

 

Thank You for your Order