Intercity Lines Payment Authorization Form


Please fill out the fields & sign below if paying with a credit card. 

Intercitylines.com – 800-221-3936 – Info@intercitylines.com – P.O Box 1299 Warren, MA

Credit Card Payments can be made using a Visa or MasterCard. 
We do not accept American Express or other cards. We do not accept payment from 3rd parties. 

Name on Credit Card:    

Date: 

Phone Number:   

Email:   

Year, Make, & Model of the Vehicle being Transported:   

Pick Up City & State:   

Delivery City & State:   

Cost of Transport:   

Billing Address:   

For your security, we will call you for your credit card #. We typically run Credit Card payment’s once pick up has been scheduled 2-3 days before. 

I, the cardholder, authorize Intercity Lines, Inc to charge my Visa or Mastercard for payment of the vehicle transport described above.

Leave this empty:

Signature Certificate
Document name: Intercity Lines Payment Authorization Form
Unique Document ID: 67601e924f92310acbbc315c06b9888c22f46cec
Timestamp Audit
October 26, 2018 11:28 am ESTIntercity Lines Payment Authorization Form Uploaded by intercity lines - dean@intercitylines.com IP 50.250.58.137