Credit Card Authorization

Credit Card Form

Card Type:(Required)
Cardholder Name (As it appears on the Card)(Required)
Please enter date in format MM/YY
Address(Required)
Max. file size: 64 MB.
Max. file size: 64 MB.
Please attach a clear picture of your Driverā€™s License for identity verification.
Max. file size: 64 MB.

PERSON AUTHORIZED TO APPROVE WORK/CHARGES OR RECEIVING SERVICE

Full Name(Required)

I certify that the information above is accurate and complete and hereby authorize the collection of payment via the above credit card for the services performed. I understand and agree to the following: Estimated charges may vary depending upon the actual conditions encountered. Should additional work be required that exceeds the estimate above, Fred Robertson Wrecker Service (company) will obtain authorization from either the cardholder, or the person indicated above as "PERSON AUTHORIZED TO APPROVE WORK/CHARGES" prior to completing additional chargeable work. The later may indicate their approval via their signature on the Cal-Nevada Towing invoice. If the "Estimated Charges" field is left blank, I agree to pay the actual charges invoiced by company. I understand the company is entitled to compensation for work performed and equipment utilized. I authorize company to charge for travel and work actually performed if the service cannot be completed due to materially inaccurate or incomplete information being provided to company. Hourly charges begin accruing when operator(s) depart base. Cancellation of service later than 15 minutes past operator departure will result in charges for their actual port to port travel time (time spent traveling from base and back).

MM slash DD slash YYYY
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Looking for a reliable wrecker service? Call Fred Robertson Wrecker Service to handle your towing, suspension, and hazmat cleanup needs.

Phone

(205) 758-4761
Fax: (205) 758-4790

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