Name on Credit Card:
Year, Make, & Model of the Vehicle being Transported:
Pick Up City:
Pick Up 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:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Payment Authorization
Agree & Sign