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CREDIT CARD AUTHORIZATION DEPOSIT FORM

Pickup Dateof appointment
job number
Name On The Contract
Please select card type:
Card Holder Nameyour full name
Credit card number
CID code
Billing address:
City:
Zip Code
Phone
Fax
Pay Amount: $

5% admin fee $[field21*0.05]

(your card will be charge 10% + 5% admin fee from this amount )

I authorize Sky Van Lines to charge my credit/debit card of the amount of :
Amount 10 %+ 5% feeyour full name

I, hereby authorize SKY VAN LINES .Inc to charge my credit/debit Card account in the amount indicated above for the 10%DEPOSIT of household goods associated with and shippers name listed on the quoteFurther more I agree all the terms andconditions related to my move. (please read your estimate)

Name
Dateof appointment


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Payment Processing

Sky Van Lines Inc will keep all information entered on this form strictly confidential.