Payment Authorization Form

ACH AUTHORIZATION FORM

If you intend on utilizing a Credit Card, please skip this page.
Please Check One Box:
Name

First NameLast Name
Transaction Amount
Reference / Invoice Number:
ex. File # OI-2611111 File # 00921564
Account Name:
Account Number:
Bank Name:
Routing Number:
Is this a personal or business account?
Type of account?
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I hereby authorize Earth Cargo, Inc. / Earth Customs, Inc. and its authorized employees to debit my account for the requested services. I understand that Earth Cargo, Inc. / Earth Customs, Inc will process my account and obtain an approval of charges performed on my behalf.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
This ACH DRAFT will be withdrawn from your bank for payment same as if it were a check issued from your own account. All rates and services are subject to ECI/NCBFFA terms and conditions. As usual, all information is kept confidential.

Credit Card Payment Authorization Form

Please complete and sign this form to authorize Earth Cargo, Inc. and/or Earth Customs, Inc. to charge the credit card listed below. By signing, you authorize us to debit your account for the specified amount on or after the indicated date.
Please Check One Box:
Type a question

Earth Subscription

$99.99 for each month

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Transaction Amount (Non-Subscription Payments)
Email
example@example.com
Reference Number / Invoice Number
ex. File # OI-2611111 File # 00921564
By signing this form, you hereby authorize Earth Cargo, Inc. and/or Earth Customs, Inc. to charge your credit card account for the amount indicated above. Unless otherwise stated, a credit card processing fee of 4% or $25.00, whichever is greater, will apply per transaction. This processing fee does not apply to subscription service payments.

I authorize the above-named business to charge the credit card indicated in this authorization form according to the terms outlined above and according to Earth Cargo, Inc. and/or Earth Customs, Inc.’s terms and conditions, which are available upon request. This payment authorization is for the goods/services described above and for the amount indicated above only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

ACH AUTHORIZATION FORM