epictransportation.bizopiaweb.com > Reservations ( DNN 2.1.2 )

* = Required

Booking Information

Passenger Name

Telephone

Address

Cell

Fax

Booking Party Name

Credit Card Holder
I hereby authorize Epic Transportation Services Inc. to charge my credit card as indicated below for my travel arrangements.

The issuer of my credit card is authorized to pay Epic Transportation Services, Inc. the amount indicated below upon presentation. I agree to pay same total sum subject to and in accordance with the agreement governing the use of such card.

I have read and fully agree with the terms and conditions governing my travel arrangements with Epic Transportation Services Inc. ALL DEPOSITS ARE NON-REFUNDABLE.

* Circle

VisaMastercardAmerican ExpressDiscover

* Credit Card Number

* Expiration Date

* CVV2 Code on Back

* Charge the Balance Amount on credit card or pay driver on Date of Service ?

* Depost Amount (Applied To Total)

* Balance Due on day of service

* Print Name As It Appears On Card

* Cards Billing Address & Zip Code

The authorized party agrees to all liability for all damages to vehicle and equipment caused by any or all occupants in the vehicle. This includes, but is not limited to all cleaning costs, repairs, or replacement.

* Card Holder Signature

IMPORTANT

Please include a photocopy of current Driver's license and front and back of your credit card.

1826 S. Orange Grove Ave., Los Angeles, CA. 90019
TEL: (866) 939-EPIC/ (323) 939-7848
FAX: (323) 375-0295

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