1 Step 1 CREDIT CARD AUTHORIZATION DEPOSIT FORM Pickup Dateof appointmentdate_range job number Name On The Contract Please select card type:AmexDiscover Visa Master card Card Holder Nameyour full name Credit card number ExpMonth010203040506070809101112 Year201920202021202220232024202520262027202820292030 CID code Billing Address: City: StateState ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Code Emaila valid emailemail Phoneicon-phone Fax Pay Amount: $ 5% admin fee $[field21*0.05] (your card will be charge 10% + 5% admin fee from this amount ) I authorize Sky Van Lines to charge my credit/debit card of the amount of : Amount 10 %+ 5% feeyour full name I, hereby authorize SKY VAN LINES .Inc to charge my credit/debit Card account in the amount indicated above for the 10%DEPOSIT of household goods associated with and shippers name listed on the quoteFurther more I agree all the terms andconditions related to my move. (please read your estimate) Name Dateof appointmentdate_range Emaila valid emailemail By pressing submit this form I'm authorize Sky van lines .Inc to charge my credit card /debit. For booking my job. and is valid for one time use only. I understand that a cancellation can be made by faxing a cancellation request to (720) 800-7481 or email to: firstname.lastname@example.org up until 72 hours prior to my move date to get a refund back for this amount Submit Form keyboard_arrow_leftPrevious Nextkeyboard_arrow_right Payment Processing Sky Van Lines Inc will keep all information entered on this form strictly confidential.