Credit Card Information Form for River Runner’s Shuttle Service
(Vehicle Shuttle)
Todays Date:__________
VISA ______ Mastercard ______ Discover/Novus _____
Name on credit card: ______________________________________________________
Address: ________________________________________________________________
________________________________________________________________
City, State, Zip
Phone number: ___________________________________________________________
Credit Card number: ______________________________________________________
Expiration date: ___________ Three digit Security Code: ____________________
(Last 3 digits of the number found on the back of your card)
Signature: _______________________________________________________________
How many vehicles to be charged to this credit card? ________________
Total amount to be charged to your card? ______________
Please fax or mail to us…see below.
Thank you.
River Runner’s Shuttle Service
P.O. Box 61
Meadview, AZ. 86444-9706
PH: (928) 564-2194
FAX: (928) 564-2781
PID: _________ Location: ______ TOD: _________ Location: ______
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