CREDIT CARD AUTHORIZATION FORM
 

Transit Mix Corp - Credit Card Authorization Form

PLEASE PRINT OUT AND COMPLETE THIS AUTHORIZATION AND RETURN TO US
WITH A COPY OF THE CREDIT CARD AND IDENTIFICATION
All information will remain confidential





Payment Information







I authorize TRANSIT MIX CORP. to charge the agreed amount listed above to my credit card provided herein. I agree that I will pay for this purchase in accordance with the issuing bank cardholder agreement. In addition to the above charge, I agree that once I release the truck for delivery, If I return any concrete back, my card will be charged and additional $50.00 per yard for disposal of concrete. I also agree that if I hold the trucks for more than the allowable dump time of (5) minutes per yard my card will be charged a $20.00 per minute overtime charge.
Cardholder – Print Name, Sign and Date Below:





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