Credit / Debit Card PaymentDelivery Payments must be paid in Cash or Postal Money order at the time of Delivery.Please note our system does not accept American Express Credit Cards.Order NumberPayment for which service*PickupStorageCorporate PaymentPickup Payment Amount* Storage Payment Amount* Company Move Payment Amount* Transaction Fee 3%* Price: $0.00 Transaction Fee 3%* Price: $0.00 Transaction Fee 3%* Price: $0.00 Total $0.00 Customer Name* First Last Credit Card Billing Address* Street Address Apt or Suite Number City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Credit Card*DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Terms of Service Section 1*I, the card holder, understand that I am making a payment for services rendered to a moving carrier for the services and materials provided to me as per my moving contract. With my electronic signature here I am confirming that I have read the publication from the Department of Transportation titled “Your Rights and Responsibilities When You Move,” and that I understand the content thereof. I am also aware that I am responsible for paying the contracted sum for all services required in order to complete my move from start to finish. I am also aware that I will be responsible for any post-contracted services required to complete the delivery of my shipment, even where not indicated in the contracts upon pickup. I also confirm here that I have read all pages, front and back, included in my moving contract with moveON moving and I understand the terms thereof. I have had the opportunity to ask a representative of moveON moving any questions that I may have had and I am satisfied with the responses that I have received. Customer IP address: 220.127.116.11Initials*Terms of Service Section 2*I, the card holder, understand this payment on my credit card represents a partial payment for the services that are being rendered to me by the moving carrier, moveON moving. I confirm that I am the card holder and authorized to make any and all charges to this card. I understand that this payment does not complete my contracted payment and that I am still responsible for the balance of any and all storage and moving services (where applicable), both contracted and post contracted, and that payment must be made per the contracted payment types and terms only. I also understand that I may not enact a charge back as a means to resolve an issue with my moving Carrier if for any reason I am dissatisfied with the services I have received including but not limited to: loss or damage of items being shipped, late delivery, property damage at points of service, disputed weight or volume charges, disputed packing charges, or services contracted and not received. I understand that a charge back is not a valid means to remedy any dispute with my moving carrier, moveON moving, and that as a party to a legally binding contract I must adhere to the contract terms and federal regulations thereof and use one of the following avenues to remedy the dispute: 1) File through the third party claims processor, Claims Service International (877) 274-0074; 2) Request legal mediation via the third party claims processor Claims Service International (877) 274-0074; 3) Enact a civil suit in the County of Clark in Nevada. I understand that any charge back processed on this transaction will result in a late fee for this payment as it will enter the invoice into a state of non-payment. Collection costs may also be assessed (where applicable) if a charge back is processed. Customer IP Address: 18.104.22.168Initials*Terms of Service Section 3*I, the card holder, understand that any reversal of this charge, or any portion of this charge, whether by myself or the banking institution attached to this card, will render my account with moveON moving to be in an immediate state of default. Accounts in default are subject to all relevant legal actions, including but not limited to: collections proceedings; civil actions; auction of properties, where applicable and per the governing jurisdictional proceedings; criminal actions where intent to defraud monies can be established and is regulated by the relevant jurisdiction. Customer IP address: 22.214.171.124Initials*I understand that this payment is for Pickup Only and that Delivery Payments must be paid in the form of Cash or Postal Money order. I understand that if payments are made in excess of the amount due on pickup that they may be rejected.* I agree to the terms of serviceI understand that this payment is for Storage Only and that Delivery Payments must be paid in the form of Cash or Postal Money order. I understand that if payments are made in excess of the amount due on pickup that they may be rejected.* I agree to the terms of serviceBy signing below, the Cardholder agree's and confirm's their agreement to abide by their Cardholder agreement and be liable for any payment to moveON moving.Signature* This iframe contains the logic required to handle Ajax powered Gravity Forms.