Booking Form

I ,  authorize Top Moving PRO to charge the following credit card account listed below in the amount of $
on/or after 

The following payment/deposit will be applied towards my upcoming relocation scheduled for 

Type of Credit Card:

Cardholder’s Name:

Credit Card Number:

Expiration Date:

Security Code: (3 Digits on Visa, MasterCard and Discover | 4 Digits on front of AMEX)

Billing Address:

By signing this agreement, Customer & Cardholder both agree to comply with and to be subject to all credit card charges specified above. Customer & Cardholder hereby agree not to dispute and/or charge-back any of the charges specified in the sections above. Any violation of these terms and conditions (hence any dispute and/or charge-back of any the sums specified), by Customer and/or Cardholder constitutes a breach of this agreement and the company will be entitled, but limited, to the remedies specified below:

REMEDIES: In the event the customer and/or cardholder dispute or initiate a charge-back of any of the monetary amounts specified in the above section (partly or whole), company will be entitled to collect any and all fees and/or damages resulted from this disputed and/or charge-back.

I ,hereby authorize the above named business to charge the credit-card indicated in this authorization form according to the terms outlined above. This payment authorization is for the services described above, for the amount indicated only, an is valid for a one-time use only. I certify that I am an authorized account user of this credit/debit card and that I will not dispute the payment with my bank/credit card company; so long as the transaction corresponds to the terms indicated in this form. All credit card charges are processed in the United States.

Leave this empty:

Signature Certificate
Document name: Booking Form
Unique Document ID: 81c27c1f14352c9eae09c2584f752c942c1f325f
Timestamp Audit
March 25, 2019 4:31 pm EDTBooking Form Uploaded by TOP Moving PRO - IP