**Please Fill in ALL information Requested Below**

**Please Sign and Send back to [email protected]**

This is to confirm AUTHORIZES 24/7 Truck $ Trailer Repair Corp. to charge the above credit card for invoice/s #

In the amount of $ :

Given by :

(Card Holder)

I authorize the above name buisness to charge credit card indicated in this authorization form according to the terms authorize above.This payment authorization is for the goods/services described above,for the amount indicated above only and it is valid for one time user only. I verify that i am the user of this credit card only and I will not dispute the payment with the credit card company , as long as the transaction corresponds to the terms indicated in this form.I understand and authorize to charge any additional parts for this services repair and will be charged seperately at the time of service.