Document g2Ygopj2oG2K4j2GBE1G22avJ
AUTO ALLIANCE
DRIVING
Authorization Agreement for Credit Card Payments
Vendor Name: Vendor Address:
Name on Card:
Type of Card (AMEX/Visa/MasterCard)
Address on Card (if different from above):
Card Number: Amount:
Expiration Date (month/year)
Authorized Signature:
Card Security Code
(on back of card)
Today's Date
Person to contact from vendor regarding the information on this form:
Name:
Phone Number:
Title:
Email Address:
Alliance of Automobile Manufacturers BMW Group Chrysler Group LLC Ford Motor Company General Motors Company Jaguar Land Rover
Mazda Mercedes-Benz USA Mitsubishi Motors Porsche Toyota Volkswagen Volvo 803 7th Street N.W, Suite 300, Washington, DC 20001 Phone 202.326.5500 Fax 202.326.5567
www.autoalliance.org
2024-EPA-05254
Sierra Club FOIA 2024-EPA-05254
ED_017426_00001680-00001
SC_EVERSPLIT0000853