Debit or Credit Card Payment Authorization Form

By signing and completing this form, you are authorizing Mr. Rescue Towing & Recovery LLC to charge your debit or credit card listed below. By signing this form, you are giving permission for Mr. Rescue Towing & Recovery LLC to debit your account for the amount indicated on or after the indicated date. This is permission for the originally indicated amount along with the 4% non-cash payment fee. This is also permission to charge your card for any additional fees such as but not limited to: added labor, waiting or working time, etc.

This payment is to serve as a NON-REFUNDABLE DEPOSIT for services that are going to be rendered at a future date and time (reservation/scheduled services) or for services that have already been rendered.

This payment is for Roadside Assistance and/or Towing. (Examples include but are not limited to: tire change, jump start, fuel delivery, lockout, winch-out, recovery and towing.)

I authorize Mr. Rescue Towing & Recovery LLC to charge the debit or credit card indicated in this Authorization Form according to the terms outlined below. This payment authorization is for the goods/services described above, for the amount indicated above. I certify that I am an authorized user of this debit or credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated below on this form.

Terms and Conditions:

NO REFUNDS, NO EXCEPTIONS!

This includes if you cancel the service that was originally requested or reserved, and you do not receive services from Mr. Rescue Towing & Recovery LLC. A variety of examples include but are not limited to: another company, good Samaritan, DOT or road ranger stopping to help, another company offering to do it quicker and/or cheaper, etc.