Credit Card Authorization Form
Tel : 1(866) 800-4507 / (613) 800-7898
Email : permits@permitszon.com
Name
____________________________________________________________________________________________________________
Billing Address
____________________________________________________________________________________________________________
(Street)
_____________________________|_______________________|_______________________________________
(City) (Province) (Postal Code)
Phone (Cell.): _____________________ Phone (Res.): ______________________________________________
Fax #: ___________________________ Email:____________________________________________________
MasterCard #: ___________________________________ Expiry Date: _________________ CVV :__________
VISA #: _________________________________________ Expiry Date: _________________ CVV :__________
I hereby authorize PERMITSZON, the right to charge my MasterCard/Visa for the purpose of paying any outstanding balance owing
to them, in respect of cost of permits and services fees. This will be used for business purposes only.
Terms and Conditions
Permit Cancellations: It is the policy of Permitszon to attempt to cancel permits immediately upon the customer's request.
Note: Cancellation of permits is ultimately decided by the Agency issuing the permit and not all cancellation request are honored or guaranteed by the Agency.
Customers are responsible for permit cost that are denied cancellation by the Agency(s), and all applicable fees.
Placement of an order on Permitszon by the purchases shall be deemed as acceptance of Permitszon's terms and conditions. Orders are accepted to the purchaser's
account being current and within its credit limit.
Billing Procedures: Permitszon, the above applicant and any subsidiaries of the same, hereafter referred to as Client, do hereby authorize Permitszon to act as the
Client’s agent, empowering Permitszon to purchase OD/OW permits and related items from authorized federal, state, and local transportation offices. Client assumes
full financial obligation for all OD/OW permits ordered through Permitszon and associated service fees billed by Permitszon. Client assumes full responsibility for
accuracy of permits once received from Permitszon. Client will receive invoices from Permitszon itemizing all transactions which will include the appropriate billing
names/numbers as directed by the Client. Client’s credit card will be billed for permits and services. A four (4%) convenience fee will be added for all credit card orders.
Termination: This agreement may be terminated by either party, at any time, with or without cause. However, both parties are bound by terms stipulated herein for
all services and OD/OW permits ordered for the Client by Permitszon prior to termination.
Binding: This Agreement shall ensure the benefit of, and be binding on, the parties hereto and their respective successors and permitted assigns.
I agree and accept the rates and terms as stated above.
Date :__________________ Authorization name : _____________________ Authorization signature _________________________
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signature
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