Credit Card Authorisation

NAME :

CARD NO :

ADDRESS :

CARD TYPE :

Security NO :

START DATE :

EXP. DATE :

TEL NO :

Issue NO :

MOBILE :

I hereby authorize LONDON CAR RENTALS to have use of my credit card to support this rental agreement with LONDON CAR RENTALS and for any of the charges that may occur for car rental, for rental agreement extension of hire, for change of vehicle, for fuel payment charges, Congestion Charges, Bus Lane and Parking Fines etc , or any damages occurred during the vehicle contract agreement on behalf of;

DRIVER’S NAME :

DRIVER’S ADDRESS :

E-Mail :

TEL NO :

MOBILE NO :

I understand that this vehicle may be booked by telephone and I do accept full responsibility for the vehicle and agree to the terms and conditions of hire as per rental agreement.

I enclose the copy of the front and back of the credit card.

Cardholder’s Signature :

Date :