DASH AUTO LOGISTICS – AR Credit Card Authorization AgreementDash Auto Logistics requires all orders to be secured with a credit card authorization form. You can pay for your transport via Check, Credit Card, Cash App, Zelle or Venmo after the time of delivery, but the credit card form must be filled out and returned. If you need to cancel this order, please provide written notice, no later than 48 hours of your scheduled pickup date to avoid a late cancellation fee of $150.00. Credit Card Authorization Terms and Conditions(Required) I have read and agree the following:Credit Card Authorization Terms and Conditions:1. Only one credit card number may be billed per account transaction. 2. All charges billable to the account designated below will be billed to the designated credit card. 3. Instructionsto change billing will only be accepted from the authorizing person indicated below. 4. Any charges confirmed by the carrier due to re-weighs, re-classification, or accessories will be charged to the credit card on file. 5. If other payment terms are chosen and payment is not made, all charges will be applied to the credit card below. Credit Card InformationCardholder Name As Shown On Card(Required) Company Name Credit Card Number(Required)Credit Card Type(Required) Master Card Visa Discover AMEX Expiration Date(Required) CVV Security Code(Required)Address(Required) Street Address City State ZIP Contact InformationContact Person (If Different from Cardholder) First Last Email(Required) Phone(Required)Fax Payment at DeliveryThe Amount Owed will Be Paid at Delivery Via:(Required) Check Credit Card Cash App Zelle Venmo App Payment Details Cash App | $Plangan1026 Zelle | 248-739-0332 Venmo | @Patrick-Langan-16 Authorization & Legal ConsentAuthorizing Person's Name(Required) First Last Authorizing Person's Title (If Applicable) Electronic Signature Legal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below. Scope of Consent By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below. Paper Copies You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies. Withdrawal of Consent You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below. Withdrawing your consent, requesting a paper copy, or updating your contact information You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices. “Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address. “Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy . “Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number. The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.Signature(Required)Signature Date(Required) MM slash DD slash YYYY HiddenOriginating URL HiddenURL PLEASE NOTE - Transaction will be from PB&J Transport, our parent company, on credit card statement.
