Credit Card Agreement Form

 

 

 

Dear Valued client,

All purpose movers appreciates your business! You must completely fill out this form.

All purpose movers requires a legible signature on this form.

This form must be accompanied with a photocopy of the front side of your Driver’s license and a photocopy of the front and back of your credit card number. Your credit card(s) will only be used for the purpose intended, and will be charged for the specified amount you authorize.

Credit Card#_______________________________ Exp. Date _______/_______

Date of Birth: ______/______/______

Name: _______________________ ____________ ________________________ (First) (Int) (Last)

Address: __________________________________________________________

City: _____________________ State__________________ Zip _____________

Phone # (______) ________ - _______ Fax: (______) ________- _________

Email Address: ____________________________________________________

 

I ____________________________________ hereby authorize all purpose movers , to charge my credit card(s) to complete a moving service , I understand this charge will appear immediately on my billing statement as all purpose movers . We kindly ask you to print out this CREDIT CARD AGREEMENT FORM for your further reference. I further agree that this payment is irrevocable.

Cardholder’s Signature: _____________________________________

Date: _____/_____/_______