CREDIT CARD AUTHORIZATION
PROCEED
 
Thank You for choosing Premier Transportation.......

 
Type of Credit Card: *


 
Company Name:

 
Name on Credit Card: *

 
Credit Card Number: *

 
Credit Card Expiration Date: *

mm/yy format, please.
 
Billing Address: *

Street Address, City, State and Zip Code
 
Name of Salesperson or Contact:

 
AUTHORIZATION *

For my convenience, I am authorizing Premier Transportation Services, LLC to execute transactions for transportation services on my credit card listed above.

By executing this form, it will not be necessary for me to sign each credit card voucher.

This authorization is valid until such time as written notice of revocation is received by Premier Transportation Services, LLC.
     
Thank you.
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