Minute Man Delivery
Credit Card Club Authorization Form
I, ____________________________________________________, hereby authorize Minute Man Delivery, to make charges to my Credit Card for transportation services or products as requested by me or authorized users of this credit card. I hereby designate as authorized users of this card the following persons to make charges on said card for arrangements in the event that I am unable to personally do so (if none state “None”):
No other persons are authorized to make charges on said account without my express authorization. In the event any of the above named persons make unauthorized charges against this card, I hereby agree to indemnify and hold blameless Minute Man Delivery, for any and all such charges, claims and liability related hereto. I agree to immediately to notify Minute Man Delivery of any changes to the identity of Authorized Users.
I fully understand the services or products are non-refundable and/or are subject to penalty fees in the event changes need to be made or services and/or products need to be cancelled.
Credit Card Type: Visa ___ Mastercard ___ Amex ___
Cardholder signature: ________________________Date________________
Please fax to: 310-327-3650.