Credit Card Authorization Form USA

TITAN MARINE DISTRIBUTION LLC

Please complete this form to authorize Titan Marine Distribution LLC to make a one time charge to your credit card listed below. By Signing this form, you give us permission to debit your account for the amount indicated on your final invoice. This is permission for a single transaction only, and does not provide authorization for any additional debits, unrelated debits or credits to your account.

Please select the correct card:*
VISAMASTER CARDDISCOVERY NETWORKAMERICAN EXPRESS

Amount charge(US Dollar) (If Amount is not known, put "as per final inv")*

Credit Card Authorization Agreement:

I authorize Titan Marine Distribution LLC to charge the credit card listed in this authorization form according to the terms herein. All parts to be paid in full upon order. Shipping and labour to be paid on completion of work. 25% re-stocking fee on all returns. Electrical components are not returnable. This payment Agreement and Authorization is for the goods/services described on the final invoice and for the amount indicated only. I hereby authorize Titan Marine Distribution LLC to charge the credit card, with no further authorization or approval from me, if payment is not made directly within 3 days after the final invoice is sent to me by Titan Marine Distribution LLC. This provision is valid for a one-time use only unless otherwise agreed to by me. If payment is not received within 10 days, a late fee will be applied of 5% and this adjustment will continue for every subsequent 10-day period by an additional 5% until full payment has been received.
From Titan Marine Distribution LLC

By clicking this box, you are agreeing to and authorizing Titan Marine Distribution LLC to charge your credit card in accordance with the terms of the Credit Card Authorization Agreement.

51685

Titan Marine Air

Credit Card Authorization Agreement: