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Axis TMS Corp
All Axis TMS Corp. services are billed directly to your credit card you have provided when creating your license online. We require you to input this information on record below.
Credit Card Type(Select One)
Please enter the following data exactly as it appears on your most recent credit card statement. We will need to match the credit card number, account name, and billing address to be able to process your account. The most frequent cause of setup delay is credit card data that is not what the credit card company has on file.
Name on Credit Card: (Exactly as printed)
Billing Address: (Street, Apt#)
City, State, Zip:
CVC / Card Code:
Authorization: By signing below, I acknowledge that I have read and agree to the terms and conditions set forth in the Master Service Agreement with Axis TMS along with the billing policies located on (http://axistms.com/legal/billing-policies/).
I warrant that I have valid authority to act for the company or I am individually responsible for this account. I authorize Axis TMS Corp. to automatically bill the credit card listed above or any card updated on the Axis TMS website in license settings for all Axis TMS licenses, products and services. Since my payment amount varies each month, I will receive notification via email of the amount charged and I agree that my card will be billed automatically until I cancel service or a new card is provided.
If this plan requires a setup fee or non-recurring fee, the initial setup fee or non-recurring will be billed at the time the system is set up. This authorization is valid until the account is terminated by letter or email to firstname.lastname@example.org
Card Holder Signature:
Axis TMS Corp 405 S Center St Royal Oak, MI 48067 | tel: 855 339 6599 | fax: 586 239 0258
I hereby consent to sign this document electronically.