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