Contact Info

Type of Account^*

Person Name^*

Email Address^*

Phone Number^*

Billing Info

Name

Email Address

Phone Number

Accounting Info

Name

Email Address

Phone Number

Any Special Requests

To Reach Reliance:

Email: Reliancegroup@live.com
Phone Number: 212-671-2263 & 718-850-9100
Fax: 212-671-2263

Note: We prefer emails for all future reservation and changes.

Reliance NY Group INC

To our valued customer:

On behalf of Reliance NY Group Inc.,You are a valuable customer/ account of Reliance NY Group, INC. It is mandatory when all reservations placed within our company it is a requirement that a credit card must be placed on file with the company either in the form of a personal credit card or a corporate credit card. Additionally when trip is placed, the customer/Companywill be required to execute a written authorization which will be provided by the company permitting the company to bill said credit card for payment after services are rendered.

Authorization Form

I have placed the below credit card on file with Reliance NY Group Inc. and understand / I Authorize all charges on the invoiceincluding any overages. I hereby authorize said credit card to be charged the invoice amount by signing below.

Credit Card^*

Name on Credit Card^*

Address on Credit Card^*

City^*

State^*

Zip^*

Card Number^*

Expiration Date^*

Code^*

Reservation number

Amount^*

Customer / Authorised CC Holder^*

Upload ID Picture^*

Enter your NYS Drivers License number or your Passport Number^*

Please Sign Here^*

All payment data is securely transmitted via HTTPS.

Client Onboarding form