Untitled Document

Make a Payment
Please Fill in all Necessary Information

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

If you need the pdf reader get it here


 

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*