Credit Card Authorization

Need to make payment on an invoice? Complete the form, and our credit team will take care of the billing. For rental customers, this credit card authorization form will be kept on file to charge until the rental unit is terminated.

Credit Card Authorization

Company Name *

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Cardholder Name *

Cardholder Name

First Name

Last Name

Card Number *

We are only able to accept Visa and Mastercard

Expiration Date *

CVV Code *

Amount of Charge *

A 2.5% surcharge applies to transactions over $5,000

Frequency *

By clicking submit, you authorize Norlift to charge this card for products and/or services rendered.

Application for New Credit Account

To apply for a Norlift credit account, please complete an application and mail / email / fax it to the attention of our Credit Department as follows:

MAIL

Norlift of Oregon, Inc.
Attn: Credit Department
P.O. Box: 68348
Portland, OR 97268

DOWNLOAD APPLICATION

EMAIL & PHONE

Erin Slater, Credit Manager
Credit@norliftor.com
(503) 905-3804

FAX

(503) 653-6966