Completing this form allows Qmadix to charge your orders automatically at the time of shipment. Qmadix will pre-authorize your credit card prior to shipment to insure funds are available. Once your order is complete, your charge will be processed for the invoice amount due.
I hereby Qmadix to automatically charge the above credit card for any purchases that I submit on behalf of the customer account listed above. I agree to pay the credit card charge in accordance with the card issuer agreement. If a discrepancy occurs or if I have a charge in question, I will contact Qmadix first to attempt to resolve any inquiries and for prior approval. If I have not taken steps to work with Qmadix in resolving a discrepancy and I initiate a dispute with the credit card issuer for any listed charges from Qmadix, I may be liable to pay a chargeback fee of $25.00 for each charge reversal and agree to pay these fees should this occur. By signing below I certify that the provided information is true and correct and that I am an authorized signer for the credit card information provided in this authorization form. .