We use Authorize.net to process online payments For questions or assistance, please call (248) 344-1144. Thank you for your business! Name* First Name Last Name Email Address* Payment InformationCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Credit Card Number Expiration Date Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 CVV2 Cardholder Name Invoice or Order Number* Amount to Pay* Billing AddressBilling Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Storage Customers OnlyStorage Customers OnlyTo have your future monthly storage charges automatically applied to this credit card, check yes. No Yes Recurring Payment Authorization - SIGN BELOWI understand that I am authorizing Premier Relocations to charge my storage payment each month, on the card below, until I have notified them in writing to cancel this transaction. Payments are processed on the 15th of each month. Reset signature Signature locked. Reset to sign again NotesNotesTotalTotal $0.00
