2525 Horizon Lake Drive, Suite 120
Memphis , TN 38133
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EFS Transportation Services, Inc.
2525 Horizon Lake Drive, Suite 120 Memphis , TN 38133 |
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| Authorization to Release Transaction Data |
| Date | |
| Account/TS# | |
| Company/TS Name | |
| Address | |
| City, State, Zip | |
| Contact Person | |
| Contact Email | |
| Phone Number | |
| Fax Number |
| This form serves as formal authorization to EFS Transportation Services (EFSTS) to transmit, on a daily basis, all transaction data processed at EFS-affiliated locations pursuant to the EFS Customer Agreement. EFS Customer, for itself and for its parent companies, subsidiaries, affiliates, successors, representatives, agents, employees, partners and assigns ("Releasors"), hereby releases and forever discharges EFSTS, its affiliates, subsidiaries, successors, representatives, agents, employees and assigns ("Releasees"), from any and all claims, liabilities, actions demands and damages, whatsoever, in law or in equity, that Releasors may hereafter have in any manner relating directly or indirectly to Transmission initiated by a third party, including without limitation, any EFS-affiliate location, cardholder, or any claim arising out of or relating to actions taken by Releasees in accordance with or in reliance upon information or instructions provided by Releasor or any other third party. |
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Authorized Signature |
Date |
| Company Name | |
| Address | |
| City, State & Zip | |
| Phone Number | |
| Fax Number | |
| Contact Name | |
| Contact Email |
| Dialup | FTP |
| Upon completion email or fax to:
Questions call 866-841-9315, ext. 16776 |