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Company Name: *
RDS Account Number: *
E-mail address: *

 

Credit Card Authorization

 

A credit card number is required for a credit to be established. By filling out the information below You are agreeing to allow RDS to charge your account for the total due on a monthly basis. The account listed above will be enrolled in this program, until such a time that it is terminated in writing. Below is the credit card(s) that you are authorizing RDS to charge.

 

 

Credit Card Authorization: Primary card

 

Cardholder’s Name: *
Address: *
City: *
State: *
Zip: *
Card Type: *
Card # * Exp. * Security Code: *

 

Credit Card Authorization: Secondary card

 

Cardholder’s Name:
Address:
City:
State:
Zip:
Card Type:
Card # Exp. Security Code

 

In opening this account, please be advised that RDS Delivery Service Co., Inc., does not take responsibility for cash, jewelry or securities. RDS Delivery Service limits its liability to maximum of 200.00 per delivery unless otherwise negotiated in writing. In consideration for credit being extended by RDS, I acknowledge and agree to the following: (1) Payment for all work performed by RDS Delivery Service is personally, jointly, severally, and unconditionally guaranteed within 15 days of billing; (2) any charges outstanding after 40 days can be charged on the credit card indicated above; (3) any charges outstanding after 60 days from date of billing are subject to collection, and all collection or arbitration expenses, attorney fees, and court costs will be borne by the purchaser; (4) all claims, requests for adjustments, or notification of errors must be made within thirty days; or charges are considered accepted; (5) RDS Delivery Service Co., Inc assumes no responsibility for the condition of the item being shipped; (6) this agreement shall apply to all current and future charges unless revocation is registered mail;(7) releases RDS Delivery Service Co., Inc., its employees and or agents from liability and responsibility for the condition of the items throughout the receipt and delivery process (8) represents to RDS Delivery Service Co., Inc. that the contents of the shipment is not hazardous or illegal in nature.(9) all work is subject to the Terms and Conditions above. My name below is confirmation that I have read and understand this agreement.

Authorized Virtual Signature *

 




   

This is great! Fast and easy. Thank you for walking us through the steps.

Rosemary Harris,
NYU Medical Center

RDS Delivery Service      436 East 11th St.   New York, NY 10009 USA     Phone: 212-260-5800     Email:     Fax: 212-260-1090
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