Proudly 100% Canadian Owned & Operated Since 2009

Credit Card Authorization

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

In Relation To*

I hereby affirm that I am the owner of the below referenced credit card and that my name is listed on the front of the credit card. I hereby authorize Canlift Equipment Ltd to chard my credit card (listed below) for payment of agreed upon purchases in the amount of:

Credit Card Type*
Clear Signature
MM slash DD slash YYYY
PO Required*
Do you require a PO?
Keep On File*
Would you like Canlift to keep your card on file for future payments?

** Do you need to provide Canlift with a PO?