Credit Card Authorization Form

 

 

I _______________________________authorize APX WORLDWIDE Inc. to charge my

Credit Card from _____ (Visa, MC)

with Credit Card number _________________________________________________

and expiration _________  CVV # ______ 

Credit Card Billing Address: ______________________________________________ 

ZIP CODE: ___________

I authorize that all charges are subject to weight and measure verification.  Should the weight and volume exceed the original estimate I authorize the charges be amended accordingly.  Likewise if the charges are less than the tendered weight and measure a credit will be issued.  I acknowledge that I am the authorized user of the above credit card account.  I authorize use of the above credit card account by APX WORLDWIDE Inc.

QUOTE # ________________________ 

AMOUNT TO BE CHARGED $__________________ 

I acknowledge and understand that the above-referenced is for services rendered on my behalf and at my request by APX WORLDWIDE INC.  I acknowledge that, by providing this service APX WORLDWIDE INC. has met its obligations for the above charge.  I acknowledge that this agreement may be cancelled if cargo has not been tendered to carrier and I agree to pay a penalty of 5% to cover transaction fees.  If cargo is already tendered to carrier, I acknowledge that this agreement may not be cancelled.

* I am enclosing copies of my credit card front and back and a picture I.D.  * Destination port charges, duties and or taxes are not included. I acknowledge that I have read and received a complete and signed copy of this agreement and of each and every document I have signed including the terms and conditions specified in our air and ocean bills of lading.

Signature of Cardholder: _______________________________________

Date: _________________________

ONLY by initialing on this line _______ I ________________________ authorize FUTURE shipments to be debited to the card.

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