credit card authorization

IMPORTANT: ALL (3) Steps Must Be Completed Below.

Authorization Form for a Single Credit Card Transaction.

Step 1: Fill Out ALL Appropriate Fields Below

Invoice Number:

Payment Amount:

Credit Card Type

Credit Card Number:

Expiration Date:

CVV Number

Name on Card:

Billing Address:

Billing City:

Billing Zip Code:

Cardholder Phone #

Todays Date:

Electronic Signature:

Legal:

I authorize the credit/debit transaction for the above purchase/invoice for services performed by CJ's Towing Unlimited, Inc. I agree to the above charges to my credit card and I am satisfied with the services rendered and agree not to dispute any of the charges with the financial institution that issued this card. This information above is true and correct to the best of my knowledge. This electronic signature is valid and is the exact name on my State Issued ID or Drivers License. I agree and I am aware that the IP address on submission of this form will be documented by CJ'sTowing & Recovery and may be used in a court of law in leiu of a handwritten signature.

credit card authorization

Step 1: Fill Out ALL Appropriate Fields Below

Step 2: After Submit Form, Upload Picture of Drivers License

Step 3: Upload Front and Back Picture of Credit Card