Online Fax Verification Form

Please complete form below all fields are required:
Customer Information
First Name;
Last Name;
Home Phone;
Cell Phone;
Quote Number;
Shipping Cost;

Credit Card Address Verification
Last 4 Numbers on Card;
Billing Address;

Zip code;
Driver License Number;
Drivers License State
Terms of Service " I agree to the " Terms of Service

"By submitting this form, you agree to PDQ Auto Movers charging your credit card in the amount listed on order form.You authorize PDQ Auto Movers to transport your vehicle(s). Acceptance of these terms negates the right to dispute the above mentioned charge for the deposit payment according to PDQ Auto Movers Terms and Conditions. Customer warrants that he/she is the registered owner and/or has been authorized by the legal owner to act as agent for the registered owner and has the authority to enter into this agreement on behalf of the owner."

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