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: Card TypeVisaMasterCardDiscoverAMEX
Credit Card Number:
Security Code: (3 Digits on Visa, MasterCard and Discover | 4 Digits on front of AMEX)
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.
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Document Name: Booking Form
Agree & Sign