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AUTHORIZE.NET SECURE PAYMENT FORM
Contact Information
Your Name
*
Phone
*
Email
*
Transport ID#
This your account number with Accredited Auto Transport. It should have been on your quote and/or emailed to you by your representative. If you don't know it, that's alright.
Card Information
Full Name as it appears on the card
*
Billing Address For Card
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Card Type
*
Visa
Mastercard
Discover
American Express
Card Number
*
Card Expiration Date
*
3 Digit Security Code
*
Authorization and Disclaimer
Amount You're Are Authorizing To Be Held
*
Questions, Comments or Concerns?
Consent To Terms & Conditions
I agree in full to the terms and conditions outlined
HERE
.
Signature
*
By signing below, I hereby agree to allow Accredited Auto Transport LLC to authorize the amount above on the credit card I have provided. I further agree that this is my credit card or that I have permission from the credit card owner to utilize the card for this transaction. I understand that Accredited Auto Transport LLC is only putting a hold on the authorized amount and will not capture the authorized amount until my transport has successfully been loaded onto a carrier.
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