One Time Credit Card Payment Authorization Form

Complete the below form to authorize A1 American Shuttle to make a one time debit to your credit card listed below.

By filling this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

I authorize A1 American Shuttle to charge my credit card account indicated below for AMOUNT on or after DATE. This payment is is for Shuttle Ride.