1 Step 1 CREDIT CARD AUTHORIZATION DEPOSIT FORM Pickup Dateof appointment job number Name On The Contract Please select card type:AmexDiscover Visa Master card Card Holder Nameyour full name Credit card number ExpMonth010203040506070809101112 Year201620172018201920202021202220232024202520262027 CID code Billing address: City: StateState ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Code Emaila valid email 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 Emaila valid email By pressing submit this form I'm authorize Sky van lines .Inc to charge my credit card /debit. For booking my job. and is valid for one time use only. I understand that a cancellation can be made by faxing a cancellation request to (720) 800-7481 or email to: email@example.com up until 72 hours prior to my move date to get a refund back for this amount Submit Form Previous Next Payment Processing Sky Van Lines Inc will keep all information entered on this form strictly confidential.