Authorization Form
To process your monthly payments, we need you to complete this form as a means of authorization. Please provide the following contact information:
Full Name
First Name
Last Name
Work Phone
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Area Code
Phone Number
Home Phone
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Area Code
Phone Number
E-mail
Billing Information
Last 4 digits of Credit Card Number
Payment Authorization
Click this button to indicate your authorization to deduct 12 monthly payment from the above listed checking account approx. 30 days after hitch ships on the 15th or 30 of the month. Note: MI residents charged applicable sales tax plus down payment. Additional shipping costs for out of the U.S. are also applied to the first payment. Failure to honor this payment agreement with Tow Safe, LLC. constitutes default of the agreement. Tow Safe, LLC. reserves the right to call the entire balance of the debt due at the time of default. Default cancels the money back guarantee. Default suspends the lifetime warranty until the entire debt is paid in full to Tow Safe, LLC
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Authorize
Signature
By selecting this button, I understand that I am sending my digital authorization to process this form.
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I accept
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