Payment Authorization

Please fill out the fields & sign below if paying with a credit card. 

Name on Credit Card:    


Phone Number:   


Year, Make, & Model of the Vehicle being Transported:   

Pick Up City:   

Pick Up State:

Delivery City:   

Delivery State:  

Cost of Transport:   

Billing Street Address:   

Billing City, State, & Zip Code:

For your security, we will call you for your credit card #. We typically run Credit Card payment’s once pick up has been scheduled 2-3 days before. Credit Card Payments can be made using a Visa or MasterCard. We do not accept American Express or other cards. We do not accept payment from 3rd parties. 

I, the cardholder, authorize Intercity Lines, Inc to charge my Visa or Mastercard for payment of the vehicle transport described above. (PLEASE DO NOT PUT ANY PUNCTUATIONS IN YOUR LEGAL NAME. IT WILL NOT ALLOW YOU TO SIGN)

Leave this empty:

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Signature Certificate
Document name: Payment Authorization
lock iconUnique Document ID: ccb17e62aa5f8b417654a63604fa97d8938a2de7
Timestamp Audit
January 17, 2023 9:38 pm EDTPayment Authorization Uploaded by Intercity Lines - IP