Credit Card Authorization Form Sample Clauses

Credit Card Authorization Form. For your convenience, we will use this authorization to charge your credit card account for your advance orders and any additional amounts incurred as a result of show site orders placed by your representative. For Third-Party pay- ers please use “Third Party Billing Agreement” form. Please complete the information requested below: Visa Master Card American Express Personal Company Card Number: Exp. Date: Card Holder’s Name (Print) Signature: CVV: City: State: Zip: • Please make all checks payable to: AGS Exposition Services, Inc. • All checks must be in U.S. currency. Check Number: • Please print show name and booth number. • Company checks must be received 14 days prior to exhibitor Amount Due: move-in to provide adequate time for processing • Orders are processed and appropriate discounts (if any) are applied on the date that your payment is received. A copy of your check by email, fax, etc. is not considered payment. • Credit Card Authorization MUST be on file with AGS Expo Services before any goods or services are rendered regardless of your preferred method of payment. AGS Expo Services • 0000 XX 00xx Xxxxxx • Orlando, FL 32811 As an exhibitor electing to use a third-party for my billable services, I understand and hereby agree that the ultimate responsi- bility for payment of all charges is mine. Further, I agree to be bound by all terms and conditions outlined in the Payment Terms and Conditions within this Exhibitor Service Manual. In the event that the named third-party fails to meet the required payment terms, charges will revert back to me, the exhibiting company. All invoices are due and payable upon receipt, by either party. Payment in full must accompany your order. Please note, we will use this authorization to charge your credit/debit card account for all orders noted above, at anytime, including those placed onsite by your representative. These charges may include all services provided by AGS Expo Services including but not limited to material handling, labor, and product orders. For tax-exempt status, within the state of the event, please submit a tax- exempt certificate. We gladly accept VISA, MasterCard and American Express. Credit Card Number: Exp. Date: Card Holder’s Name: CVV: Signature: Credit Card Billing Address: City: State: Zip: AGS Expo Services • 0000 XX 00xx Xxxxxx • Orlando, FL 32811 AGS Expo Services has established the following terms and conditions of sale and rental for all services rendered by AGS to all clients, exhib...
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Credit Card Authorization Form. I hereby authorize Xxxxxx Xxxxx, MA, LPC-Intern to maintain a record of my credit card and my signature on file for payment of the following services: psychotherapy services, including deductibles, co-pays, non-cancelled or late- cancelled appointment fees, any charges owed that are not covered by my insurance company, and the litigation policies that are set forth in the Informed Consent Agreement. These charges include, but are not limited to, payment of retainer for court/deposition/legal proceeding preparation and appearance, consultation and telephone appointments, report and letter writing, and completion of disability paperwork. My signature below authorizes Xxxxxx Xxxxx, MA, LPC-Intern to charge my credit card for all applicable charges on an on-going basis. I understand that if I decide to terminate services with Xx. Xxxxx, and my account is paid in full upon termination, I may withdraw the authorization to charge my credit card in the future. In the event your credit card expires, or is lost or stolen, of if you desire to use another credit card, please notify us and we will have you complete a new Credit Card Authorization Form, and will shred your old information. We are equipped to utilize Health Savings Account cards, and accept MasterCard, Visa, Discover and American Express. Client Name: Cardholder’s Name (as it appears on the credit card): Credit Card Billing Address (the address where the credit card statement is received) Street Apt/Suite City and State Zip Code Credit Card Type Visa MasterCard Discover AMEX
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Credit Card Authorization Form. Note: Only fill out the following information if you are paying with a credit or debit card.
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Credit Card Authorization Form. Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until canceled.
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Credit Card Authorization Form. As a Client of Premier Office Suites, LLC, (“Premier”), I , authorize Premier to charge the credit card listed below, for any and all fees associated with the Services outlined in the Virtual Office Services Agreement.
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Credit Card Authorization Form. I hereby authorize NME Surveillance LLC to charge my credit card for: • Start-up fees; • Alarm Monitoring Service(s) • Alarm Installation and Equipment; • Service Call Charges and Alarm Components; • Programming Changes; • Requested reports; • Recovery Charges of Proprietary Account Data Belonging NME Surveillance LLC; □ Visa □ MasterCard □ American Express (add 3%) Cardholder: Credit Card billing address: Expiration date: Email address for electronic receipt: Authorized Signature:
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Credit Card Authorization Form. As a Client of ViewPointe Executive Suites, LLC (“ViewPointe”), I, , authorize ViewPointe to charge the credit card listed below, for any and all fees associated with the Services outlined in the Virtual Office Services Agreement.
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Credit Card Authorization Form. 2020-2021
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Credit Card Authorization Form. If you are a customer that pays by Credit Card you must sign a credit card authorization form. • PHOENIX MOBILE AIR, INC. only accepts Visa and MasterCard.
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Related to Credit Card Authorization Form

  • Credit Card Authorization I understand and consent to the use of the credit card provided without original signature on the charge slip, I understand that by "clicking" that I have read the terms and conditions of this property, I am bound by this agreement and I have signed "electronically, and that this Credit Card Authorization cannot be revoked and will not terminate until 90 days after leased premises are vacated. Charges may include but not limited to: unauthorized long distance telephone, cable, satellite TV or internet charges, damages beyond normal wear and tear.

  • Board Authorization Prior to delivering notice of the proposed terms of an Agency Transaction or a Principal Transaction pursuant to Section 1 (or at such time as otherwise agreed between the Company and the Agents), the Company shall have (i) obtained from its board of directors thereof all necessary corporate authority for the sale of the Shares pursuant to the relevant Agency Transaction or Principal Transaction, as the case may be, and (ii) provided to the Agents a copy of the relevant board resolutions or other authority.

  • Required Authorizations There is no requirement to make any filing with, give any notice to, or obtain any Authorization of, any Governmental Entity as a condition to the lawful completion of the transactions contemplated by this Agreement.

  • ACH Authorization Merchant authorizes Bank or its agents or designated representatives to initiate debit and credit entries and adjustments to the Settlement Account or the Reserve Account (described in Section 13 of the MPA) through the ACH settlement process for amounts due under the Merchant Agreement. This authorization will remain in full force and effect until termination of the Merchant Agreement and the full and final payment of all obligations of Merchant due under the Merchant Agreement. Merchant acknowledges and agrees that Bank will not be liable for any delays in receipt of funds, any failure by Merchant to receive funds, or errors in debit or credit entries caused by Merchant, or third parties, including but not limited to any Card Association or any financial institution.

  • Credit Card Agreements Each Borrower and Guarantor shall (a) observe and perform all material terms, covenants, conditions and provisions of the Credit Card Agreements to be observed and performed by it at the times set forth therein; (b) not do, permit, suffer or refrain from doing anything, as a result of which there could be a default under or breach of any of the terms of any of the Credit Card Agreements and at all times maintain in full force and effect the Credit Card Agreements and not terminate, cancel, surrender, modify, amend, waive or release any of the Credit Card Agreements, or consent to or permit to occur any of the foregoing; except, that, any Borrower or Guarantor may terminate or cancel any of the Credit Card Agreements in the ordinary course of the business of such Borrower or Guarantor; provided, that, such Borrower or Guarantor shall give Agent not less than ten (10) Business Days prior written notice of its intention to so terminate or cancel any of the Credit Card Agreements; (c) not enter into any new Credit Card Agreements with any new Credit Card Issuer unless Agent shall have received not less than ten (10) Business Days prior written notice of the intention of such Borrower or Guarantor to enter into such agreement (together with such other information with respect thereto as Agent may request) and such Borrower or Guarantor delivers, or causes to be delivered to Agent, a Credit Card Acknowledgment in favor of Agent; (d) give Agent immediate written notice of any Credit Card Agreement entered into by such Borrower or Guarantor after the date hereof, together with a true, correct and complete copy thereof and such other information with respect thereto as Agent may reasonably request; (e) furnish to Agent, promptly upon the request of Agent, such information and evidence as Agent may require from time to time concerning the observance, performance and compliance by such Borrower or Guarantor or the other party or parties thereto with the terms, covenants or provisions of the Credit Card Agreements; and (f) not modify any instructions given by Agent to any Credit Card Issuer or Credit Card Processor provided for in any Credit Card Acknowledgement or otherwise direct the remittance of payments under any Credit Card Agreement to any account other than the Blocked Account.

  • Authorization, Etc This Agreement and the Notes have been duly authorized by all necessary corporate action on the part of the Company, and this Agreement constitutes, and upon execution and delivery thereof each Note will constitute, a legal, valid and binding obligation of the Company enforceable against the Company in accordance with its terms, except as such enforceability may be limited by (i) applicable bankruptcy, insolvency, reorganization, moratorium or other similar laws affecting the enforcement of creditors’ rights generally and (ii) general principles of equity (regardless of whether such enforceability is considered in a proceeding in equity or at law).

  • Authorization for Agreement The execution and performance of this ---------------------------- Agreement by Licensee and Manager have been duly authorized by all necessary laws, resolutions or corporate action, and this Agreement constitutes the valid and enforceable obligations of Licensee and Manager in accordance with its terms except as such enforceability may be limited by creditors rights laws and general principles of equity.

  • Card Information Updates and Authorizations If you have authorized a merchant to xxxx charges to your card on a recurring basis, it is your responsibility to notify the merchant in the event your card is replaced, your card information (such as card number and expiration date) changes, or the account associated with your card is closed. However, if your card is replaced or card information changes, you authorize us, without obligation on our part, to provide the updated card information to the merchant in order to permit the merchant to xxxx recurring charges to the card. You authorize us to apply such recurring charges to the card until you notify us that you have revoked authorization for the charges to your card.

  • Letter of Authorization Each Party is responsible for obtaining a Letter of Authorization (LOA) from each End User initiating transfer of service from one Party to the other Party in accordance with applicable law. The Party obtaining the LOA from the End User will furnish it to the other Party upon request. The Party obtaining the LOA is required to maintain the original document, for a minimum of twenty-four (24) months from the date of signature. If there is a conflict between an End User and Carrier regarding the disconnection or provision of services, Frontier will honor the latest dated Letter of Authorization. If the End User’s service has not been disconnected and services have not yet been established, Carrier will be responsible to pay the applicable service order charge for any order it has placed. If the End User’s service has been disconnected and the End User’s service is to be restored with Frontier, Carrier will be responsible to pay the applicable nonrecurring charges as set forth in Frontier applicable tariff to restore the End User’s prior service with Frontier.

  • AGENT AUTHORIZATION FORM I/We, (Print Bidder name) , Do hereby authorize (print agent’s name), , to act as my/our agent to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, (IFB NUMBER AND TITLE) , and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Signature of Bidder Date STATE OF FLORIDA ) COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) I affirm that an employee leasing company provides my workers’ compensation coverage. I further understand that my contract with the employee leasing company limits my workers’ compensation coverage to enrolled worksite employees only. My leasing arrangement does not cover un-enrolled worksite employees, independent contractors, uninsured sub-contractors or casual labor exposure. I hereby certify that 100% of my workers are covered as worksite employees with the employee leasing company. I certify that I do not hire any casual or uninsured labor outside the employee leasing arrangement. I agree to notify the County in the event that I have any workers not covered by the employee leasing workers’ compensation policy. In the event that I have any workers not subject to the employee leasing arrangement, I agree to obtain a separate workers’ compensation policy to cover these workers. I further agree to provide the County with a certificate of insurance providing proof of workers’ compensation coverage prior to these workers entering any County jobsite. I further agree to notify the County if my employee leasing arrangement terminates with the employee leasing company and I understand that I am required to furnish proof of replacement workers’ compensation coverage prior to the termination of the employee leasing arrangement. I certify that I have workers’ compensation coverage for all of my workers through the employee leasing arrangement specified below: Workers’ Compensation Carrier: A.M. Best Rating of Carrier: Inception Date of Leasing Arrangement: I further agree to notify the County in the event that I switch employee-leasing companies. I recognize that I have an obligation to supply an updated workers’ compensation certificate to the County that documents the change of carrier. Signature of Owner/Officer: Title: Date: If the bidder is submitting as a joint venture, please be advised that this form MUST be completed and the REQUESTED written joint-venture agreement MUST be attached and submitted with this form.

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