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CREDIT CARD AUTHORIZATION 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]

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


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Payment Processing

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