Credit Card Authorization Form Book now before the quote is expired Please see our Privacy Policy for information on what personal information we collect and how we use such information. 212.705.8773Chat With Us SSL SECURED PAYMENT Your information is protected by 256-bit SSL encryption Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Cardholder Name *Please enter the name as it appear on the cardPassenger NameIf different from cardholder nameCardholder Email *We'll send the receipt and any trip updates to the primary email you enter.Cardholder Phone *(for text messages)Card Number *Expiration *Only 4 numbers, No slash or Dash. Example 0122CVC *The 3 digit (back) or 4 digit (front) value on your card.Billing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSignature * Clear Signature On smart phone - use your finger to sign. If you're using a mouse, please hold the left button and signTerms of Service Agreement *By providing a valid and primary credit card, Customer is expressly authorizing that all charges for Services, Products and Usage based overages, including taxes and fees to be billed on this card.TERMS AND CONDITIONS 1. INTRODUCTION Please read these Terms and Conditions carefully. By using the Service, you agree that you have read and understood the terms in these Terms and Conditions which are applicable to you. These Terms and Conditions constitute a legally binding agreement (“Agreement”) between you and NYNJ Taxi Corp DBA NYC Wheelchair Transportation. The Agreement applies to your use of the Service provided by NYNJ Taxi Corp DBA NYC Wheelchair Transportation. If you do not agree to the Terms and Conditions, please do not use or continue using the Service. Thank you for making NYNJ Taxi Corp DBA NYC Wheelchair Transportation, your choice for private transportation. To ensure the most pleasant travel experience, please take a moment to read the important information below. It is also advised that you review the enclosed confirmation for accuracy. We are here for you! Reach us at +1.212.705.8773 Did you know? Planning your trip with us is easier than ever! There are three ways to book your private transportation 24 hours: Online - Visit us at NYCWheelchairTransportation.com Call US- Call us anytime, at any of the numbers listed above and a representative will be happy to help. E-mail- INFO@nycwheelchairtransportation.com We have cars, vans, limos, and buses. Wheelchair Accessible Vehicles available 24 Hours. We can transport any size group. Schools, Corporate Accounts, Weddings, Proms, Special Events, Long Distance Trips, and Deliveries are all welcome! 2. MODIFICATION NYNJ Taxi Corp DBA NYC Wheelchair Transportation reserves the right to modify the terms and conditions of this Agreement, and such modifications shall be binding on you only upon your acceptance of the modified Agreement. NYNJ Taxi Corp DBA NYC Wheelchair Transportation reserves the right to modify any information on pages referenced herein from time to time and such modifications shall become effective upon posting. Continued use of the NYNJ Taxi Corp DBA NYC Wheelchair Transportation Services after any such changes shall constitute your consent to such changes. Unless material changes are made to the arbitration provisions herein, you agree that modification of this Agreement does not create a renewed opportunity to opt-out of arbitration (if applicable). 3. REPRESENTATIONS, WARRANTIES AND UNDERTAKINGS By using the Service, you represent, warrant / undertake that: 1. You are at least eighteen (18) years old, or that you have the legal capacity to enter into the Agreement; 2. All the information which you provide shall be true and accurate; ● You will only use the Service for the intended and lawful purposes; and 1. You will not try to interrupt or harm the Service in any way. 4. CHARGES As a customer/client, you understand that request or use of NYNJ Taxi Corp DBA NYC Wheelchair Transportation Services may result in charges to you. Charges for NYNJ Taxi Corp DBA NYC Wheelchair Transportation Services include fares and other applicable fees, tolls, surcharges, and taxes. NYNJ Taxi Corp DBA NYC Wheelchair Transportation has the authority and reserves the right to determine and modify pricing at any given time. You are responsible for all charges incurred for instance, in the event we double park the car in the street and we get a ticket, NYNJ Taxi Corp DBA NYC Wheelchair Transportation has a right to charge your card for that ticket or waiting fees. Fees and Other Charges ● Service Fee - You may be charged a “service fee” for each ride as billed by NYNJ Taxi Corp DBA NYC Wheelchair Transportation at the end of each trip. ● Prime Time – At certain times, including times of high demand for NYNJ Taxi Corp DBA NYC Wheelchair Transportation services (“prime time”), you acknowledge that charges may increase substantially. ● Cancellation Fee – You may only cancel a ride under the circumstances provided herein. Please check our cancellation clause for more details. ● Damage Fee – In the event, you materially damage our vehicle, you agree to pay a “damage fee” of up to $250 depending on the extent of the damage (as determined by NYNJ Taxi Corp DBA NYC Wheelchair Transportation in its sole discretion), towards vehicle repair or cleaning. NYNJ Taxi Corp DBA NYC Wheelchair Transportation reserves the right (but is not obligated) to verify or otherwise require documentation of damages prior to processing the damage fee. ● Tolls – In some instances tolls (or return tolls) may apply to your ride. You undertake to pay for all toll charges as and when they are required. In addition to that tolls will be charged at the end of the trip, because the route maybe changed by the driver, in case the driver needs to detour because of a traffic jam after the driver will report the route and NYNJ Taxi Corp DBA NYC Wheelchair Transportation will charge the card on file. ● Additional gear or staff needed to complete the job. If you didn't describe your needs completely, for example, but not limited to: if you failed to tell us that there are stairs, we need to lift you over, or you gave us the wrong number of steps we need to lift you over, or if the passenger weight supplied by you is less than the actual weight, and as a result of that we need to dispatch additional staff members or gear, we have the right to revise the confirmation and add the fees and charge your card. ● Other Charges – Other fees and surcharges may apply to your ride including actual or anticipated airport fees, state or local fees. In addition, where required by law NYNJ Taxi Corp DBA NYC Wheelchair Transportation will collect applicable taxes. Facilitation of Charges All charges are facilitated through a third-party payment processor. NYNJ Taxi Corp DBA NYC Wheelchair Transportation may replace its third-party payment processor without notice to you. Charges shall only be made through NYNJ Taxi Corp DBA NYC Wheelchair Transportation. NYNJ Taxi Corp DBA NYC Wheelchair Transportation may group multiple charges into a single aggregate transaction on your payment method based on the nature of the charges and/or the date (s) they were incurred. Refunds NYNJ Taxi Corp DBA NYC Wheelchair Transportation will be able to cancel before 7 days of the service with a non-refundable fee of 20% if you choose to leave the funds for future trips; NYNJ Taxi Corp DBA NYC Wheelchair Transportation will credit your account without penalties. However cancellation within 7 days, there will be no refund, still, you will be able to use the funds for future trips minus 20% for the cancellation, the funds will never expire. For Ambulette or Ambulance, there will be no refunds regardless of how long the trip was canceled before the date of the service but you will be able to keep the funds to be used for future trips minus 30% non-refundable for the cancellation. NYNJ Taxi Corp DBA NYC Wheelchair Transportation places these fees as a safeguard to ensure there is no loss of revenue because once payment for the trip has been received; NYNJ Taxi Corp DBA NYC Wheelchair assigns a vehicle and driver to the trip in the calendar. Credit Card Authorization Upon addition of a new payment method or each ride, NYNJ Taxi Corp DBA NYC Wheelchair Transportation may seek the authorization of your selected payment method to verify the payment method, ensure the ride cost will be covered, and protect against unauthorized behavior. In order for NYNJ Taxi Corp DBA NYC Wheelchair Transportation to secure the vehicle for a trip, NYNJ Taxi Corp DBA NYC Wheelchair Transportation must collect full payment for the trip, whether it’s a one-way trip or a round trip, NYNJ Taxi Corp DBA NYC Wheelchair Transportation will collect full payment. 5. CANCELLATIONS If you need to cancel your booking, you must immediately fill out the cancellation form located on our website found in the link herein; https://satnamsakshi.com/nycwheel/cancellation-survey-form/ NYNJ Taxi Corp DBA NYC Wheelchair Transportation will apply a 100% administration/transaction charge on all bookings when you fail to fill out the cancellation form as requested hereinabove. No Show In case you failed to submit the cancellation request form at least 24 hours before the agreed service time, the trip will be treated as a “No Show” and we keep the right to apply a 100% administration/transaction fee. 6. LIABILITY NYNJ Taxi Corp DBA NYC Wheelchair Transportation will take reasonable endeavors to get you to your destination on time, but we shall not be liable for any vehicle breakdowns, accidents, or traffic delays that are beyond our control. Under no circumstances shall NYNJ Taxi Corp DBA NYC Wheelchair Transportation be liable for any loss of profits, business, or for any indirect or consequential loss whatsoever. All luggage and personal items are carried entirely at your own risk. NYNJ Taxi Corp DBA NYC Wheelchair Transportation recommends that you have personal adequate travel insurance in force. 7. HOW DO WE CHARGE FOR A ROUND TRIP When reserving a round trip, NYNJ Taxi Corp DBA NYC Wheelchair Transportation will create one confirmation which will only be charged once. This means that the initial quote sent by NYNJ Taxi Corp DBA NYC Wheelchair Transportation only applies to one way and the receipt that we issue to you clearly states so. To further put this into perspective, the routing information entails only a pick-up address and a drop-off address which is covered by the cost in the description for example “each way amounts to 1X 188.0.” At the point that you acknowledge this and submit payment information, NYNJ Taxi Corp DBA NYC Wheelchair Transportation has the liberty to charge for this one way and will further proceed to create a return trip confirmation with a unique number which will also be charged as well. Based on the foregoing NYNJ Taxi Corp DBA NYC Wheelchair Transportation will issue you with two receipts. At the time that NYNJ Taxi Corp DBA NYC Wheelchair Transportation is creating the information, it is a necessity that we save the information alongside a pick-up time therefore we recommend that unless you are requesting a specific pick up time from NYNJ Taxi Corp DBA NYC Wheelchair Transportation, we will not come for the return trip time as indicated in the return confirmation. In the alternative, the confirmation will exist in a unique status where NYNJ Taxi Corp DBA NYC Wheelchair Transportation will wait for you to contact us when ready for the return trip. This acts as a measure of ensuring our customers do not pay waiting fees in the event they are not ready. 8. WRONG ADDRESS In case we arrive at the address supplied by the customer, and we find out that this address is wrong, we will update the correct address in the reservation, the customer will be responsible to pay the difference cost due to the address change if any. 9. PRODUCT NOT AS DESCRIBED When taking your reservation, we make sure to ask for all the details we need to perform your transport or other services requested by you, the right way to perform the job, for example, but not limited to: A. which vehicle to use, B. Which gear we use to perform the job, C. How many staff members will perform the job is reserved to the dispatch manager to decide. Still, this is our responsibility to execute the job in a professional and safe way, best suited to the conditions described by the booking person that booked this trip/job. You agree not to dispute the charge for this job/ride, even if you do not agree with the decision of how to execute this job by the dispatch manager 10. LATE ARRIVAL OF AMBULETTE OR AMBULANCE We always plan ahead of the driver's route and make new reservations only if the timeline works, we will never take new reservations if we know that the driver will be delayed for the agreed pick-up time. In rare cases, when a patient that is riding with the driver that is scheduled to pick you up, has a medical emergency, we will rush the patient to the nearest hospital, or ground the vehicle and wait for an emergency unit to arrive and treat that rider. In this case, you understand that the driver will be late for the agreed pick-up time as agreed. 11. PENDING PICK UP (HOSPITAL DISCHARGE ETC) When you’re scheduling an Ambulette or an Ambulance service for a hospital discharge or transfer, or any other transport where you not yet sure when will you be available for that pick-up, we will reserve the transportation and send you a receipt at a random time, (as we need to select the exact time to be able to save and create your reservation) but in our end, this ride will be marked as “Pending Pick-Up” that means that we will not attempt to pick up at the time stated in the reservation, but we will wait for your call to request the pick-up, in this case, as soon as you call to request the pick-up, we will send your request for dispatch, and wait for the closest driver to become available for your pick-up, you understand that each driver has a pre-scheduled route, and must attend to those rides first, we commit to you, to give you priority and service you first, before servicing new reservations received from the same day of the agreed service date. There is no set time that we can guarantee, but in most cases, if your pick-up address is within NYC, wait time can take one hour or more, and outside the NYC metro area can take 2 hours or more, but again time may exceed one hour even in the NYC metro area. 12. BY HOUR SERVICE The minimum time required for “By the hour service” is 3 hours, if the trip will last more than 3 hours, we will add additional hours to the reservation and charge the card on file. 13. NEVER OFFER PAYMENT TO DRIVERS Base rate and gratuity are collected at checkout; this is due to safety reasons and to make your experience smooth by not having to worry about paying the driver on the day of your transport. Please never offer payments to the driver as they can be viewed as a solicitation of our drivers for private rides outside of NYNJ Taxi Corp DBA NYC Wheelchair Transportation services. 14. CAR TYPE We offer regular or wheelchair-accessible vehicles, 3 Passengers, and up to 8 passengers in a wheelchair accessible or up to 56 passengers in a regular passenger. When ordering certain class IE Economy/Basic/VIP/Executive you will get our default and most popular vehicle (Mercedes Metris) unless at the time of your trip all Mercedes Metris are fully booked you will be the next to get this vehicle, but if all of the Metris is booked, you will receive the same class vehicle, which is the Toyota Sienna or Dodge Caravan. If you reserved a certain vehicle, please make sure your reservation mentioned the specific vehicle (Not a vehicle class IE Economy/Basic/VIP/Executive). 15. NEW FACE-COVER POLICY Face covers or masks will be mandatory for everyone riding or driving with us. This policy is designed to help protect the health and safety of you and your driver and will go into effect on May 18, 2020. When wearing a face cover or mask, make sure it covers your face from the bridge of your nose down to your chin. 16. NO FRONT-SEAT PASSENGERS To allow for more distance between you and your driver, we are advising riders to no longer sit in the front seat. This means every ride with us will have one fewer passenger seat available. 17. AIRPORT TRANSFERS You must allow sufficient time when booking your ride to allow for the check-in times required by your airline and for any delays caused by traffic conditions. NYNJ Taxi Corp DBA NYC Wheelchair Transportation shall not be responsible for any delay caused by your failure to allow enough time to reach your destination or if the passengers are not ready for collection at the booked time. You must order a suitable car size for the number of passengers and luggage. NYNJ Taxi Corp DBA NYC Wheelchair Transportation cannot guarantee to carry excessive amounts of luggage. Please note that a child, no matter what age, counts as one passenger. If you need to transport a wheelchair please specify this at the time of booking. NYNJ Taxi Corp DBA NYC Wheelchair Transportation will always check for flight delays before the driver leaves for the airport but can only rely on the information supplied by NYNJ Taxi Corp DBA NYC Wheelchair Transportation. Once you have accepted your quotation, please check your booking confirmation carefully and inform NYNJ Taxi Corp DBA NYC Wheelchair Transportation promptly of any errors. NYNJ Taxi Corp DBA NYC Wheelchair Transportation shall not be responsible for any delays caused or costs arising from your failure to provide NYNJ Taxi Corp DBA NYC Wheelchair Transportation with correct information. All car parking charges shall be paid on the day of collection from the airport by the customer unless otherwise stated/agreed in advance. Please make sure to call or text 212.705.8773 as soon as you land, informing us about your arrival will give the driver enough time to head in your direction and meet you at the passenger pick-up platform without delays. Payments can be made by credit and debit cards. A full receipt will be emailed directly to you. Please note that an emailed receipt can take up to 48 hours. 18. THE SERVICE 'VEHICLE CONDUCT' You shall be responsible for the behavior of all passengers in the car during the whole journey. A charge of $250 will be levied to cover the cleaning costs in the event that the vehicle is soiled by any passenger. Eating and drinking in cars are not permitted. Exceptional circumstances for babies and medical reasons will be permitted with prior permission. All children should be restrained in a manner that befits the laws and regulations at the time. Suitable child seats should wherever possible be supplied and fitted by the child's parent/guardian. These can be held by the driver in the event of a return journey booking. NYNJ Taxi Corp DBA NYC Wheelchair Transportation will not carry more passengers than its insurance or licensing allows. Smoking is never permitted in any of our vehicles. 19. DISPUTES You agree to waive your respective rights to resolution of disputes in a court of law by a judge or jury and agree to resolve any dispute by arbitration, as set forth below. This agreement to arbitrate (“Arbitration Agreement”) is governed by the Federal Arbitration Act (“FAA”); but if the FAA is inapplicable for any reason, then this Arbitration Agreement is governed by the laws of the State of New York, including NYC. Code tit. 10, § 5701 et seq without regard to choice of law principles. This Arbitration Agreement survives after the Agreement terminates or your relationship with NYNJ Taxi Corp DBA NYC Wheelchair Transportation ends. Any arbitration under this agreement will take place on an individual basis; class arbitrations and class actions are not permitted. You understand if you have an unpaid balance to NYNJ Taxi Corp DBA NYC Wheelchair Transportation and do not make satisfactory payment arrangements, your account may be placed with an external collection agency. You will be responsible for reimbursement of any fees from the collection agency, including all costs and expenses incurred collecting my account, and possibly including reasonable attorney’s fees if so incurred during collection efforts. In order for NYNJ Taxi Corp DBA NYC Wheelchair Transportation or its designated external collection agency to service your account, and where not prohibited by applicable law, You agree that NYNJ Taxi Corp DBA NYC Wheelchair Transportation and the designated external collection agency are authorized to (i) contact you by telephone at the telephone number(s) you are providing, including wireless telephone numbers, which could result in charges to you, (ii) contact you by sending text messages (message and data rates may apply) or emails, using any email address you provide and (iii) methods of contact may include using prerecorded/artificial voice message and/or use of an automatic dialing device, as applicable. You fully understand that NYNJ Taxi Corp DBA NYC Wheelchair Transportation shall not tolerate and/or entertain any disputes pertaining to you not showing up at the particular venue and at the agreed time, in the event, you claim NYNJ Taxi Corp DBA NYC Wheelchair Transportation has created a duplicate charge which is not the case as this has been extensively illustrated, Roundtrip charges as explained under clause 7 as well as Ambulette stair assist where the number of the staff members to help in lifting a person over the steps and/or the gear NYNJ Taxi Corp DBA NYC Wheelchair Transportation uses to lift a person over the steps such as a wheelchair, stair chair will be determined by the dispatcher, in the event you refuse to receive the service because you misunderstood the mechanisms we apply to lift over the stairs, NYNJ Taxi Corp DBA NYC Wheelchair Transportation will automatically apply the No Show Policy. NYNJ Taxi Corp DBA NYC Wheelchair Transportation will NOT entertain disputes based on the following claims which have been fully addressed in these terms and conditions:- 1. A claim by the customer for multiple charges on the services offered by NYNJ Taxi Corp DBA NYC Wheelchair Transportation. 2. A claim by the customer disputing the quality of services offered. 3. An incident involving the customer not showing up after requesting our services. 4. An incident whereby the cardholder does not recognize the charge for our services thus reporting it as fraudulent. 5. A customer’s request for a refund after payment has been processed. 6. DISCLAIMER OF WARRANTIES NYNJ Taxi Corp DBA NYC Wheelchair Transportation makes no representation, warranty, or guarantee as to the reliability, timeliness, quality, suitability, availability, accuracy, or completeness of the Service. NYNJ Taxi Corp DBA NYC Wheelchair Transportation does not represent or warrant that (a) the use of the Service will be secure, uninterrupted, free of errors or other harmful components, or operate in combination with any other system or data, (b) will meet your requirements or expectations, (c) any stored data will be accurate or reliable, (d) the quality of any service obtained by you, will meet your requirements or expectations. The Service is provided to you strictly on an “as is” basis. All conditions, representations, and warranties, including any implied warranty of merchantability, fitness for a particular purpose, or non-infringement of third party rights, are hereby excluded to the extent permissible by law. NYNJ Taxi Corp DBA NYC Wheelchair Transportation makes no representation or warranty of any kind whatsoever express or implied, in respect of Services provided by Third Party Providers. You agree that you shall bear all risk arising out of your use of the service and shall have no recourse to NYNJ Taxi Corp DBA NYC Wheelchair Transportation in respect of the same. 21. NO WAIVER The failure of NYNJ Taxi Corp DBA NYC Wheelchair Transportation to enforce any right or provision in the Terms and Conditions shall not constitute a waiver of such right or provision. 22. ASSIGNMENT These Terms and Conditions as modified from time to time may not be assigned by you without the prior written approval of NYNJ Taxi Corp DBA NYC Wheelchair Transportation but may be assigned without your consent by NYNJ Taxi Corp DBA NYC Wheelchair Transportation. Any purported assignment by you in violation of this section shall be void. 23. ENTIRE AGREEMENT This Agreement comprises the entire agreement between you and NYNJ Taxi Corp DBA NYC Wheelchair Transportation and supersedes any prior or contemporaneous negotiations or discussions.The cost is for each way as it appears in the quote: "Each Way". Please follow the links and read our policies. No Alcohol is allowed in NYNJ Taxi vehicles. Overtime: If you hired a driver by the hour and the trip takes longer than the time contracted, you will be charged hourly as needed with 10 min grace time. Car Damages: The customer is responsible for any damage to the vehicle from cigarettes (No Smoking is allowed in our vehicles)EmailSubmit SSL SECURED PAYMENT Your information is protected by 256-bit SSL encryption Need Assistance? Call Us Now 212.705.8773