Auto-Recharge Payment Form - Liz Theresa
CONTACT LIZ  
Become the star you know you are.
High-End Web & Marketing Services
  • Card Holder Authorization: By submiting this form I, the above-named authorized credit card holder, give your moving company express authorization to charge my credit card. I understand that this form constitutes a legally binding contract and that by affixing my signature to this form, I will be held responsible for all agreed upon charges as well as any and all collection and legal fees. This credit card is authorized for charges outlined on estimate and any additional charge required to finish the accepted job. By signing this "Credit Card Authorization" form, I/my organization acknowledge receipt and understanding of its contents, including all terms.

  • NOTE: Your card will not be automatically charged by completing this form; however completing and submitting this form does give our company the right to charge the card for the amount of deposit and any balances due. This is permission for future transactions, and provides authorization for additional debits or credits to your account.