1 Step 1 CREDIT CARD AUTHORIZATION 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] Total payment + 5%your full name I authorize Sky Van Lines to charge my credit/debit card of the amount of : $[field47] I, hereby authorize SKY VAN LINES.Inc to charge my credit/debit Card account in the amount indicated above for the relocation / storage of household goods associated with and shippers name listed on the bill of lading Further more I agree that these charges are valid and accurate andare payment for service and labor rendered And/or materials sold. Name Dateof appointment Emaila valid email By pressing submit I'm authorize Sky van lines .Inc to charge my credit card /debit. For the transportation related expenses on my household goods. and is valid for one time use only. Submit Form Previous Next Payment Processing Sky Van Lines Inc will keep all information entered on this form strictly confidential.