galaxyfreightservices

1. alaxy Freight Services, Inc. 2700 Greens Road, Bldg. K -300 • Houston, Texas 77032 P.O.Box 60681 • Houston, Texas 77205 281.442.SHIP Tel • 281.442-7445 Fax 877.602.SHIP Toll Free Credit Card Authorization Form Galaxy Ref. No.________________ Name as it appears on Card _____________________________________ Credit Card Billing Address: Address____________________________________________________ City______________________State_________ Zip_________________ Country______________________ Telephone_________________________________ Cellular___________________________________ Email( if you would like a receipt send via email) ___________________________________________________ Fax (if you would like a receipt sent via fax)________________________________________________________ Card Type Number Exp.Date □ American Express □ Master Card □ Visa □ Discover Card Number □□□□-□□□□-□□□□-□□□□ Expiration Date□□ / □□ Driver’s License #______________________________State_________ Amount authorized $_______________________________ Signature________________________________________ www.galaxyfreightservices.com International • Domestic • Air • Ocean • Truck