Credit Card Information

Company:

*Name on Card:

*Billing Address:
Please fill out if different then street address above

*City:

*State:

*Zip Code:

*Card type Select... Master Card Visa American Express

*Card Number:

*Expiration Date:

*CVV2:

Note: the CVV2 can be found in the signature area on the back of the credit card. The number is located after the card number. On American Express cards, the CVV2 number can be found on the front of the card, above and to the right of the imprinted card number.

Authorization

*Authorize

*All rates are based on the shipment information that has been provided and may be adjusted due to the factors including, but not limited to, the following; differences in weight, freight classification, and accessorial charges for services that are performed but not requested.

*Transit times quoted are estimates ONLY! They are deemed to be reliable, BUT are NOT guaranteed. Estimated transit times do not include the day of pick-up.

*Consignee must inspect all freight carefully at the time of delivery and make all appropriate notations on the delivery receipt in the presence of the driver.

*Transportation & Logistical Concepts is a Transportation Broker and NOT a Motor Carrier. Cargo claims must be handled directly between the shipper, consignee, and the carrier.

All orders are subject to cancellation charges, including any and all costs incurred by or charged to Transportation & Logistical Concepts.

The customer agrees to pay for any and all costs associated with the shipment of their goods. If additional fees are assessed by the freight carrier, customer will be alerted and the customer's credit card will be billed for the additional costs. Customer agrees that all claims and/or billing disputes will be handled through the carrier directly.

The venue and jurisdiction of any dispute arising out of this agreement and/or relationship between Transportation & Logistical Concepts and the other parties to this agreement including, but not limited to, disputes over individual shipments, shall be brought in Orange County Municipal Court, Fullerton, CA.

*Authorized Name
MUST BE AN OFFICER OF THE COMPANY OR PERSON AUTHORIZED TO SIGN

*Email:

*Date

*Required