Credit Card Authorization Form - Accurate Forklift

To protect both you and your company from unarthorized credit card usage we require the below form to be completed. We also require a copy of the front and back of the credit card and a copy of your drivers license. Enter your credit card details exactly as shown on your credit card and billing statement.

Name On Card

Company Name

Billing Address

City / State / Zip

Location Address (If Different from Billing)

City / State / Zip

Email Address

Phone Number

Checkboxes

Visa Mastercard American Express Discover

Expiration Date

Date

Authorize Name

We will contact you for the credit card number. If you have any questions you can contact sales at 770-692-1455.

File Upload (copy of Card and Drivers License)

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