Towing Leads Agreement Please Fill Out The Information Below Credit Card Authorization Name* First Last Company Name* Your Title* Email* Phone We Should Forward Calls*Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Service Area*Chose Your service AreaAustin TXDallas TXDenver COColorado Springs COChicago IL (Northside)Detroit MIGreensboro NCIndianapolis INLouisville KYMiami FLOklahoma City OKOrlando FLRaleigh NCSan Antonio TXSacramento CATampa FLTulsa OKWichita KSOther LocationWhat's Your Service Area?* How Many Weekly Calls?*Choose Your Weekly Call Volume25 Calls Weekly30-35 Calls Weekly40-45 Calls Weekly50-55 Calls Weekly60-65 Calls Weekly70-75 Calls Weekly80-85 Calls Weekly90-95 Calls Weekly100 Calls Weekly*How Many Weekly Calls?*Choose your Weekly Call Volume25 Calls Weekly30-35 Calls Weekly40-45 Calls Weekly50-55 Calls Weekly60-65 Calls Weekly70-75 Calls Weekly80-85 Calls Weekly90-95 Calls Weekly100 Calls WeeklyCouponTotal Next Billing Cycle $0.00 We will NOT Charge Your Credit Card during Your FREE TRIAL. Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Terms Of Service* I Have read and agree to the Terms of Service listed below.I authorize Strategic Marketing Group to charge my credit card weekly for payment of services in the amount total on this form. If Strategic Marketing is unable to process my payment; I will be responsible for an alternate payment arrangement and any resulting processing fees that may be incurred. This authorization is in effect until I notify otherwise in writing. By signing this authorization, I acknowledge that I have read and agree to all of the above information and warrant all information provided is true and correct. THIS AGREEMENT REMAINS IN EFFECT UNTIL CANCELED BY THE APPLICANT WITH WRITTEN NOTICE. The applicant, by providing Strategic Marketing Group with a written notice, may cancel this agreement at least 7 days in advance of the cancellation date. Today's Date* MM slash DD slash YYYY SignatureCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
