Credit Card Authorization | Reliable Crane Service

Credit Card Authorization for Crane Equipment Rentals

This credit card authorization form gives us the permission to charge your card. This form is not the payment.

Authorization Date *

Email *

Customer Name *

Sales Person *

Telephone *

Invoice/Quote/Job number (if known)

Customer Billing Address *

City *

State *

Zip *

Type of Card

Visa MasterCard Discover American Express

Card Number *

Name as printed on Card *

Card Billing Address (If different from Customer billing address above) *

Expiration Date *

Security Code *

Total Charge Amount *

Terms:

I hereby affirm I am authorized to use the credit card indicated above to purchase goods and/or services from Reliable Crane Service, LLC.
If a Tax Exemption (TE) and/or Direct Pay Permit (DPP) are provided and taxes are not included in the document(s) above, I agree to pay all State and Local Taxes in the event the TE or DPP are later denied by Reliable Crane Service, LLC Tax Department, and agree these amounts will be charged to the credit card listed above. If Taxes are included, and the TE / DPP approved, the tax amount will be refunded to the card above.
A 4% convenience charge will be added to all credit card transactions.

I authorize Reliable Crane Service, LLC to charge my credit card to pay for the documents and/or contracts and amounts listed above and below and agree to be bound by the terms of this authorization letter and agree to pay the Credit Card issuer according to the terms of my contract with them. This form is good for charges up to $25,000.00 for a single transaction. All additional charges need additional confirmation from the customer.

PRINT NAME OF INDIVIDUAL AUTHORIZED TO USE CARD:

SIGNATURE OF INDIVIDUAL NAMED: *

This form will be kept on file for six months after the last transaction date then destroyed. email to

email to lisa@reliablecraneservice.com

Credit Card Authorization for Crane Equipment Rentals

Terms:

CA: Physical Yard location

NV:

AZ: