Credit Card Authorization


This form is to serve as authorization for payment for services provided by Civic Van Lines, DBA Shleppers Moving & Storage, as described in our legal contracts. 

Cardholder’s Name:                                           Job/Estimate #:  

Billing Information:

Address:                                                                                            

City:  

State:                            

 Zip:  

Email:  

Amount to Charge:  

Credit Card Number:                Expiration Date:                                               CVC:  

 

 

 

 

Leave this empty:

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Signature Certificate
Document name: Credit Card Authorization
lock iconUnique Document ID: 56c9140033bb47ee7ccdf7bbfed32364eb555e18
Timestamp Audit
March 14, 2023 4:16 pm PSTCredit Card Authorization Uploaded by Shleppers Moving & Storage - info@shleppers-ca.com IP 98.149.176.34
March 14, 2023 4:22 pm PSTBilling Department - billing@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 98.149.176.34
March 14, 2023 4:41 pm PSTBilling Department - billing@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 98.149.176.34