Common Contracts
1 similar Credit Card Authorization Agreement contracts
Credit Card Authorization AgreementCredit Card Authorization Agreement • April 22nd, 2019
By signing this agreement I am authorizing Envisions Counseling, LLC to bill my credit card, health savings account card, flexible insurance spending account card, checking account or debit card for all professional services rendered to me, my spouse or on behalf of my minor children or other family members. I acknowledge that I have read and agree to Section 7 located on the Informed Consent regarding session fees, debt collections and court proceedings. I agree not to dispute any charges which may include but are not limited to the following:
