BQ Transport LLC | Long Distance Movers | 866-668-3896

Credit Card Authorization Form

Customer Name

1. The following is an (“agreement”) entered upon between BQ TRANSPORT, LLC. DOT# 3218067
And 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 cards
charges specifies above. Customer hereby agrees not to dispute and/or change back any of the
changes specified on section 1 above. Any violation the terms and conditions (hence dispute
and/or charge back of any of the sums specified on sections 1). By customer constitute a breach
of this agreement and the company will be entitle, but not limited, to the remedies specified on
section here to.

3. Remedies:
In any case the customer dispute or charge back any of the moments specifies on section 1
above (partly or a whole), or section 1 above (on top of the amount sum disputed). Customer
agrees 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 accept
the 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.



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:

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Signed by BQ Transport, LLC
Signed On: July 28, 2020

BQ Transport LLC | Long Distance Movers | 866-668-3896
Signature Certificate
Document name: Credit Card Authorization Form
lock iconUnique Document ID: 8c33914f59ba300059732aaca00a7b7337c5fa1f
Timestamp Audit
February 20, 2020 1:29 pm ESTCredit Card Authorization Form Uploaded by BQ Transport, LLC - IP