Pre-Payment Form

Please print, sign and fax this form to (201) 907-0026

AGREEMENT BETWEEN: KISMET LIMOUSINE A NEW JERSEY CORPORATION having its principal place of business at

800 Cedar Lane, Teaneck New Jersey 07666

DATE:______________/_______________________/____________________

CREDIT CARD TYPE:

_______AMEX_______ VISA _______MASTERCARD _______DISCOVER _______DINERS CLUB

NAME AS IT APPEARS ON CARD:__________________________________________________

CREDIT CARD NUMBER:_________________________________________________________

EXPIRATION DATE:______________/_______________________/______________________

SECURITY CODE:____________
(Last 3-digits on reverse of the credit card.)


I HEREBY AUTHORIZE KISMET LIMO TO USE THE CREDIT CARD LISTED ABOVE TO PAY FOR MY                      
TRANSPORTATION CHARGES WITH KISMET LIMOUSINE SERVICE.

Signature:__________________________________________

Title:______________________________________________

Date:____________________________Accepted by:__________________________________

HOME INFORMATION

HOME ADDRESS:______________________________________________________________

CITY:_________________STATE:____________________ZIP:__________________________

PLEASE FAX BACK WITH A COPY OF FRONT AND BACK OF CREDIT CARD