NOTICE TO CARDHOLDER: PLEASE READ BEFORE SIGNING

The cardholder hereby authorizes all actual charges for the above-listed Merchant order number(s) be charged to the cardholder’s above-described credit card. The cardholder authorizes the estimated charges to be pre-authorized within one week of the load date by the above-listed Merchant. The actual moving charges will be the final audited costs of all services performed, including the original services requested and additional moving/supplemental services approved or requested by cardholder or otherwise required in order to accomplish the safe transportation (as defined by federal law) of the shipment. Cardholder agrees that his/her signature on this form constitutes his/her “signature on file” and is his/her agreement to pay and authorize to charge all final audited charges include any supplemental charges as described above. The final actual audited charges may be charges within 72 hours of loading.