PAYMENT AUTHORIZATION: By signing below, I confirm I am an authorized cardholder and permit Bristol Wrecker Service to charge the payment method provided separately through an approved secure payment channel for the service entered on this form, up to the maximum dollar amount I specify. Any additional charge beyond that amount requires separate approval unless another written agreement or applicable law applies. This form is not a payment processor and does not waive legal rights. For security, enter ONLY the last four card digits and billing ZIP here. NEVER provide the full card number, expiration, CVV or bank account details on this form or by email.