Credit Card Authorization Form:

* Required Field

Please fill out the form below to sign up for an Enterprise Courier Delivery Service account.

Company Name: *
Company Address: *
Room/Floor #:
City: *
State: *
Zip: *
Phone: *
Fax #:
E-mail address: *

If your billing address or email is different from your general correspondence: Billing address is the same as above
A/P Contact:
A/P Address:
Room/Floor #:
City:
State:
Zip:
Phone:
Fax #:
E-mail address:

Type of Business: *
Years Established: *
How did you hear about us? *
Average spend on courier/shipping per month?*

Credit Card Authorization

By filling out the information below you are agreeing to allow Enterprise Courier to charge your account for the total due. The account listed above will be enrolled in this program, until such a time that it is terminated in writing. Below is the credit card(s) that you are authorizing Enterprise Courier to charge.

Name on Credit Card: *

Address: *

City: *

State: *

Card Type: *

Card #: *

Exp.: * format 00/00

Security Code: *

Enterprise Courier limits its liability to maximum of $200.00 per delivery unless otherwise negotiated in writing. I acknowledge and agree to the following: (1) Payment for all work performed by Enterprise Courier personally, jointly, severally, and unconditionally guaranteed upon completion of the service; (2) all claims, requests for adjustments, or notification of errors must be made within thirty days; or charges are considered accepted; (3) Enterprise Courier, assumes no responsibility for the condition of the item being shipped; (4) this agreement shall apply to all current and future charges unless revocation is registered mail; (5) releases Enterprise Courier, its employees and or agents from liability and responsibility for the condition of the items throughout the receipt and delivery process (6) represents to Enterprise Courier, that the contents of the shipment is not hazardous or illegal in nature. (7) all work is subject to the Terms and Conditions above.

My name below is confirmation that I have read and understand this agreement.

Authorized Virtual Signature: *