Stripe Payment Billing Name(Required) Email(Required) Phone(Required)Shipper Name(Required) First Registration Number(Required) Booking Office(Required)Please select booking officeLa Crosse, WIMinneapolis - St. Paul, MNRochester, MN Billing Address(Required) Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Payment Amount(Required)Subtotal$0 Processing Fee$0 Total Due$0 Consent(Required) By clicking pay, I (we) agree to the terms and conditions listed below.(Required)Bank Account Terms & Conditions: By clicking pay, I (we) authorize Piepho Moving & Storage to debit the bank account specified above for charges for the above shipper’s use of Piepho Moving & Storage’s services. I (we) understand that this authorization will remain in full force and effect until I (we) notify Piepho Moving & Storage that I (we) wish to revoke this authorization. I (we) understand that Piepho Moving & Storage requires at least ten (10) days prior notice in order to cancel this authorization. I (we) also understand that Title 49 of the U.S. Code dictates that motor carriers must collect all transportation charges in accordance with their published tariffs. Under Feder Law, the obligation to collect transportation charges is separate and distinct from the claims handling procedure. Any refund is subject to an audit by our accounting department. Credit Card, Google Pay, and Apple Pay Terms and Conditions:By clicking pay, I (we) authorize Piepho Moving & Storage to charge my (our) credit card for charges for the above shipper’s use of Piepho Moving & Storage’s services. I agree to pay for all charges in accordance with the rules and regulations governing my move. I understand that Title 49 of the U.S. Code dictates that motor carriers must collect all transportation charges in accordance with their published tariffs. Under Federal Law, the obligation to collect transportation charges is separate and distinct from the claims handling procedure. Any refund is subject to an audit by our accounting department. Credit card transactions are subject to a 2.5% surcharge to help offset the costs of processing. You have less balance Pay Δ
