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Please Fill in all Necessary Information

You may also Download this application as a pdf file and fax it in

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Credit card Authorization

“I authorize Air Land Express Inc. to charge my credit card for courier service”

Amex Discover Visa Master Card

Card Number : Expiration date:

Name appearing on Credit Card:

Email:

Complete address of credit card holder including zip code :

Telephone :

Pick up from :

Delivery To :

Amount $

Today’s Date:

Authorization#

Reference #

*SHIPMENTS WILL NOT BE DISPATCHED UNTIL CREDIT CARD IS APPROVED*