Credit Card Authorization Form
Job# Customer Name 1. The following is an (“agreement”) entered upon between BQ TRANSPORT, LLC. DOT# 3218067And the (“Customer”).Cardholder Name Credit Card Number Billing Address Expiration Date Security Code
Amount Charged (please add 4% fee to all Credit Cards, No Fee for Debit Card charges): 2. Terms and Conditions:By signing this agreement, Customer agrees to comply with and to be subject to all credit cardscharges specifies above. Customer hereby agrees not to dispute and/or change back any of thechanges specified on section 1 above. Any violation the terms and conditions (hence disputeand/or charge back of any of the sums specified on sections 1). By customer constitute a breachof this agreement and the company will be entitle, but not limited, to the remedies specified onsection here to.3. Remedies:In any case the customer dispute or charge back any of the moments specifies on section 1above (partly or a whole), or section 1 above (on top of the amount sum disputed). Customeragrees that company will also entitle for all fees and/or damages resulted from this dispute.4. By signing this agreement the customer acknowledge that he/she read, understand and acceptthe agreement by its entirety. The agreement becomes effective upon customers signature.I, hereby acknowledge that I've read and understand all of the above terms.Name
If the customer is NOT the cardholder, please provide a copy of both a photo ID and the card being charged for security purposes.
Leave this empty:
Your legal name
Your email address
Signed by BQ Transport, LLC
Signed On: July 28, 2020
If you have questions about the contents of this document, you can email the document owner.
Document Name: Credit Card Authorization Form
Agree & Sign