Common Contracts

AutoPay Enrollment - Credit Card Authorization Agreement

Credit Card Authorization Agreement • June 19th, 2014

• Contract Type
  Credit Card Authorization Agreement
• Filed
  June 19th, 2014

Bill To Account #: Set up new AutopayChange existing credit card info. Please email the completed form to: Newcustomers@bausch.com or fax it to 866-366-9783 Bausch +Lomb Inc.1400 N. Goodman St., Customer Acct Maint. Rochester, NY 14609 – Area 58 VISA, MASTERCARD, & AMERICAN EXPRESS ACCEPTED  By completing this form you are authorizing Bausch + Lomb to charge your credit card for the amount for the ‘Amount Due’ that is listed on the statement. A detailed statement showing the invoices will still be mailed to you. The secondary card (optional) will be used in the event that the primary card cannot be processed.  I, as the cardholder, will be responsible for notifying the Credit Department one month in advance if cancellation of this service is required or if there are any changes to the card information listed below. Please check the day of month that you would like your payment to be processed:1st 5th 10th 15th(If no date is selected, the 10th will be entered) Primary Card