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Credit Card Authorization Form

One-Time & Balance Payments


POLICIES:

  • Payment is considered late after the first of the month. Any outstanding balance will be charged to the card on file. In addition, a late fee will be assessed in the amount of $50.

  • Payment made for services delivered by this firm are non-refundable; you agree that you will first contact the firm before disputing any charges with the card issuer.

  • In the case of retained services, any unused funds will be refunded to the card on file within thirty days of termination of representation.

  • Being the authorized cardholder or the Corporate Officer, by signing below, I understand and agree to the terms set forth in this agreement, agree to pay, and specifically authorize the firm to charge my credit card for the services provided. I further agree that in the event my credit card becomes invalid, I will provide a new valid credit card upon request, to be charged for the payment of any outstanding balances owed.

I authorize:
I hereby authorize to charge the balance currently due in the amount entered below.
I hereby authorize to charge the balance due each month, as reflected on the cardholder’s invoice. Payment will be processed on the first of each month for the prior month’s fees.
Credit Card Type
Mastercard
Visa
American Express
Discover Card
Other
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