Login Multimodal | Crossing Borders to Deliver Excellence

CREDIT CARD AUTHORIZATION FORM

Company Name:*

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Representative Name

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Primary card of file

One time use

Remove and replace credit card on file

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This is a single use authorization and must be completed each time the credit card will be charged. Amounts will vary per transaction based on the order amount plus an additional 3% convergence fee per transaction where allowed by law.

Invoice Number:*

Invoice Amount:*

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This is an open authorization to allow charges to my credit card for all orders placed with Login Multimodal, LLC. Amounts will vary per transaction based on the order amounts plus an additional 3% convience fee per transaction where allowed by law.

Remittance Email:*

Net Due Date - From Invoice:*

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Name as it appears on the card:

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Last:

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Billing Address

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Credit Cards Accepted:*

Credit Card Number:*

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Expiration Date:*

With a synergy of over 200 years of combined expertise, our team's knowledge of the evolving transportation environment allows us to prepare our customers for tomorrow's business demands.

Quick Links

Contact

877-261-6367 info@loginmultimodal.com

Corporate Office

254 Chapman Rd.,

Suite #208 #5443

Newark, DE 19702

Branch Office

2211 E. Missouri Ave

Suite #221

El Paso, TX 79903