Sign and complete this form to authorize East Coast Towing Inc 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 for indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.
I authorize the above named business to charge the credit card indicated in this authorization
form according to the terms outlined above. This payment authorization is for the
goods/services described above, for the amount indicated above only, and is valid for one (1)
time use 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; so long as the transaction corresponds to the terms
indicated in this form.