ONE TIME CREDIT CARD PAYMENT

ONE TIME CREDIT CARD PAYMENT
AUTHORIZATION FORM

Sign and complete this form to authorize NDOVU LOGISTICS, LLC to make a one-time debit to your credit
listed below.
By signing this form, you give us permission to debit your account for the amount indicated on or after
the indicated date. This is permission for a single transaction only and does not provide authorization for
any additional unrelated debits or credits to your account.
PLEASE COMPLETE THE INFORMATION BELOW:
I ___________ authorize NDOVU LOGISTICS, LLC to charge my (full name)
Credit card account indicated below for _ on or after ____
(amount) (date)

______________________.
(sdescription of goods/services)
Billing Address ___________ Phone ____________
City, State, Zip ___________ Email________________________

SIGNATURE: ____________ DATE: ______________
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms and
conditions outline above. This payment authorization is for the goods/services described above, for the amount indicated
above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute
the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. THERE
ARE NO REFUNDS FOR GOODS OR SERVICES.

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