Credit Card Authorization | Road Scholars Moving

Dear Credit Card Holder,

In order to charge your credit card when you are not present to sign the receipt, please complete this form with the current information and your electronic signature. This signature indicates that you authorize charges to be made to your credit card (below); for moving, storage and/or packing charges rendered by Road Scholars Moving & Storage.

Complete form, prior to date(s) of service. Thank you for your help in preventing unauthorized charges to your credit card. We appreciate your business!
Name*
(Name of person/firm, the service is booked for)
First Last
Date of Service*
MM slash DD slash YYYY
Name*
(Name of person, paying for services)
First Last
Email*
Phone*
Credit Card Info
Credit card number (16 digits)*

(We only accept MasterCard, Visa or Discover)
Credit card expiration date (4 digits)*

(Month and year)
Credit card security code (3 digits)*
(On reverse side of card)
Zip code associated with card (5 digits)*

(Zip code used to mail card statement)
Card Owner's Signature*
Date of Signature*
MM slash DD slash YYYY
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Credit Card Info