Carrier Authorization

CARRIER AUTHORIZATION
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This document authorizes GoToLady Trucking & Logistics Solutions, LLC. to charge the credit card below for payments when you are not present. This means that your signature is not needed on the credit card slip to be accepted as payment.
Name of Company
Phone Number
Please enter a valid phone number.
Name as shown on card

First NameLast Name
Authorization Date

MonthDayYear
Date
Type of Card
CC Number
Expiration Date

MonthDayYear
Date
CVV (3-digits on back of card)
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please charge the above Credit Card to pay for the following invoices. (Complete 2nd form if more than 10 BOLs)
Invoice #      Date
Invoice #      Date
Invoice #      Date
Invoice #      Date
Invoice #      Date
Invoice #      Date
Invoice #      Date
Invoice #      Date
Invoice #      Date
$$$$$$$$$
Revenue Total
Dispatch Commission Fee
CC Processing Fee at 3% of Dispatch Fee
BOL Upload

Cancelof
GRAND TOTAL
Signing this form gives GoToLady Trucking & Logistics Solutions permission to charge your credit card for this week's Dispatch Commission payment of this invoice's Grand Total, plus an addition 3% CC Processing Fee.
Should be Empty:

CARRIER AUTHORIZATION