MFS Inc
Credit / Debit Card Authorization
Fill out all 5 steps below, then tap "Save as PDF" at the bottom.
🔒 Secure Form
Step 1 — Who You Are
Tell us who is authorizing this card.
Please pick a date
Please enter your company name
Please enter your full name
Step 2 — Card Details
The card MFS Inc will charge for services.
Card Type *
Please select your card type
Please enter your card number
Required
Required
Please enter the name on your card
Step 3 — Billing Address
Use the address your bank has on file — it must match exactly.
Please enter your street address
Required
Required
Required
Required
Step 4 — Read the Agreement & Sign
This is a legal agreement — read it before signing.
What you're agreeing to: By signing below, you are giving MFS Inc permission to charge the card you entered above for on-site emergency road services. You confirm you are the authorized cardholder.
No refunds. All charges are final. There are no refunds once services have been provided.
No chargebacks. You agree not to dispute or reverse any charge made by MFS Inc through your bank or card issuer. Filing a chargeback is a breach of this contract. If you have a concern, contact MFS Inc directly to resolve it.
Your Signature * — draw with your finger or mouse below
☝️ Sign here — use your finger on mobile, or your mouse on desktop
You must sign the form before saving
Step 5 — Upload Photos
We need both sides of your card and your ID. 4 photos total.
How to get a clear photo: Lay the card or ID flat on a dark surface. Make sure all 4 corners are in frame and the text is readable. Tap Take Photo to use your camera — or Upload if the photo is already saved on your device.
💳 Credit / Debit Card — front & back
Card — Front
Card — Back
🪪 Driver's License or Government-Issued ID — front & back
ID — Front
ID — Back
When the print dialog opens, choose "Save as PDF" as the destination.
The saved PDF will have 3 pages: form · card photos · ID photos.
The saved PDF will have 3 pages: form · card photos · ID photos.