Common Contracts

1 similar Credit Card on File Agreement contracts

Credit Card On File Agreement
Credit Card on File Agreement • September 9th, 2021

We have implemented a policy which enables you to maintain your credit card information securely on file with Richmond Creative Counseling (RCC). In providing us with your credit card information, you are giving RCC permission to automatically charge your credit card on file for your (or any other patient(s) you have listed on this form) co-pays/co-insurance, outstanding balances, services, and/or products.

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