United Refueling LLC Online Credit Card Authorization Form

Please complete all fields required. You will receive an auto response confirming your credit card submission. Thank you.

Customer Name and Billing Information

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Credit Card Information

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Cardholder - Please Enter your Name and Date

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By clicking submit you are authorizing United Refueling LLC to Charge the amount on the Invoice (or future gallons/pre-fuel purchases if applicable) You agree to pay for purchase(s) in accordance with the issuing bank cardholder agreement Under Section Labeled "Cardholder Please Enter Name and date" You Agree By typing your name in the text field "Print Name" that is defined as signature and equal to for online purposes in the event the card processed results in a dispute in an effort to not pay for services and goods provided. United Refueling LLC Term conditions apply to credit card form completed online.