CREDIT CARD AUTHORIZATIONCredit Card Authorization Agreement • May 15th, 2019
At the time of reservation, the credit card provided will be charged a 50% deposit to hold your order. The balance will be charged two business days before your order is scheduled to leave our warehouse. Any remaining balances including add-ons, loss or damage will be charged upon the return of your order. A 3% processing fee will be added to all credit card charges. If applicable, this agreement also authorizes the card holder as a third-party sponsor payer responsible for all charges corresponding to the invoice listed.
This Agreement has been made in compliance with the provisions of statutory regulations including the provisions of the regulations of the Financial Services AuthorityCredit Card Authorization Agreement • September 28th, 2021
Berkenaan dengan pemberian fasilitas kartu kredit BNI, dengan ini memberikan persetujuan menjadi pemegang Kartu Kredit BNI dengan segala fasilitas yang melekat dan tunduk pada semua ketentuan dan syarat yang berlaku pada kartu kredit BNI sebagaimana tercantum pada Formulir Aplikasi Kartu Kredit, Buku Petunjuk Layanan Kartu Kredit, Website BNI (www.bni.co.id), Lembar Penagihan dan Media Promosi BNI.
AutoPay Enrollment - Credit Card Authorization AgreementCredit Card Authorization Agreement • 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
Credit Card Authorization Agreement 2017 – 2018 School YearCredit Card Authorization Agreement • February 1st, 2022
AGREEMENTCredit Card Authorization Agreement • April 28th, 2022
Until further notice, I authorize Digestive Disorders Associates, Maryland Diagnostic & Therapeutic Endo Center, and Maryland Anesthesia Providers to charge the patient-responsible balances on my account to the following credit card:
CREDIT CARD AUTHORIZATION FORMCredit Card Authorization Agreement • October 16th, 2013
*Please complete this authorization form and return to us. All information will remain confidential. Name as it Appears on the Card: Billing Address:
Mile High Orthotics Lab Credit Card Authorization FormCredit Card Authorization Agreement • September 9th, 2015
This form is to authorize Mile High Orthotics Lab, Inc. to charge monthly account balances for products and services purchased directly to credit card accounts. The transaction for the monthly statement balance will occur on the 10th of the month following the statement date.
Taylor Rental of Naples is an employee owned company.Credit Card Authorization Agreement • May 31st, 2013
CREDIT CARD AUTHORIZATION & AGREEMENTCredit Card Authorization Agreement • February 8th, 2017 • California
AGREEMENT TO PAY: The Purchaser (“Purchaser”) agrees to honor all credit card charges for product purchased from PAINTCRAFT SUPPLY & HARDWARE CO., INC. (“PAINT”). Should the credit card be declined, (“PAINT”) may demand payment, prior to any further shipments.
Credit Card Authorization FormCredit Card Authorization Agreement • September 8th, 2020
Payment is due at the time of service. This is your agreement to make payment for services rendered and will cover any balance on your account (i.e. in situations of insurance claim processing). This information will be stored securely for future transactions. It is your responsibility to update Bayer NeuroBehavioral Center, PLLC whenever a preferred and/or updated credit card is received.
EASY BILLING CREDIT CARD AUTHORISATION AGREEMENTCredit Card Authorization Agreement • June 1st, 2018
Our easy billing options give you DISCOUNTS, which means MORE MARGIN without the need to worry about when your bill is due.
Credit Card Authorization Agreement 2018 – 2019 School YearCredit Card Authorization Agreement • June 25th, 2018
Credit Card Authorization AgreementCredit Card Authorization Agreement • September 28th, 2023
AutoPay Enrollment - Credit Card Authorization AgreementCredit Card Authorization Agreement • 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
Credit Card Authorization FormCredit Card Authorization Agreement • January 11th, 2017
Credit Card Authorization FormCredit Card Authorization Agreement • January 27th, 2023
Being the cardholder or Corporate Officer, by signing below I understand and agree to the terms set forth in this agreement, agree to pay, and specifically authorize to charge my credit card, for the charges listed above.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 outstading balances owed. I furthermore confirm that I have received all services and goods to satifactory conditions, and I will not chargeback this amount.
ContractCredit Card Authorization Agreement • July 23rd, 2020
EMAIL this completed form to: holdensanchez2@llnl.gov For LLNL/IPO Internal Use Only License Agreement #: Authorization #: Description / Invoice #:
Credit Card Authorization Agreement For Pre-Authorized PaymentsCredit Card Authorization Agreement • April 22nd, 2024
Credit card Authorization FormCredit Card Authorization Agreement • August 17th, 2020
MDOW can directly charge your credit card for payments. Please complete section below for first time use or to make account changes and return to MDOW.
LMR International, Inc. Credit Card Authorization Form and Agreement.Credit Card Authorization Agreement • December 13th, 2013
Being the cardholder or Corporate Officer, by signing below I understand and agree to the terms set forth in this agreement, agree to pay, and specifically authorize LMR International Inc. to charge my Credit Card, for one Credit Money Machine Pro Plus software the amount of:
O’Sullivan Moving & Storage Co.Credit Card Authorization Agreement • March 29th, 2016
Should my card be declined at any point during my rental period I authorize O’Sullivan Moving to continue to attempt to process the card for any past due balance.
Company NameCredit Card Authorization Agreement • August 26th, 2020
The undersigned has read and agrees to all of the terms and conditions, and labor rates of this rental agreement. The undersigned authorizes Encore to charge the above listed credit card for the equipment, labor and/or services detailed in this agreement, and for any client approved add-ons and change orders.
Credit Card Authorization AgreementCredit Card Authorization Agreement • December 21st, 2016
Please complete the following form to allow us to process your credit card transaction. Upon completion, please either email this form to eft@fortstjohn.ca, fax to 250-787-8191, mail to or hand deliver to City Hall at the address above. The completed form and a signature is required.
FOUR MONTH PAYMENT PLANCredit Card Authorization Agreement • August 22nd, 2021
Total amount due will be taken in 4 equal installments. Payments via credit card will be taken monthly (on the 15th of the month or the workday following).
Phone: 4105528885 Fax: 410-826-3835Credit Card Authorization Agreement • October 23rd, 2019
Credit Card Authorization AgreementCredit Card Authorization Agreement • August 20th, 2021
By my signature below I agree to pay according to the relevant card issuer agreement held by me. I hereby authorize The Codrington School, The International School of Barbados to retain my below signature on file and charge my card as indicated below.
Please place your Credit Card in this space and copy.Credit Card Authorization Agreement • January 25th, 2004
CREDIT CARD AUTHORIZATION AGREEMENTCredit Card Authorization Agreement • March 2nd, 2012
This Agreement shall authorized MD Audio, Engineering to process sales drafts for pre-authorized orders and recurring payments for the following account(s);
Credit Card Authorization Agreement _Dianna CooperCredit Card Authorization Agreement • July 28th, 2017
CREDIT CARD AUTHORIZATIONCredit Card Authorization Agreement • February 3rd, 2015
Billing Address: City: State: Zip: Indicated Card type: ർ VISA ർ Master Card ർ Discover ർ American Express Indicated Card Number: Name On Indicated Card: Expiration Date of Indicated Card (mm/yy): Backup payment method: ർ VISA ർ Master Card ർ Discover ർ American Express Number of Card to be Charged Subsequently Name On Card to be Charged Subsequently: Expiration Date of the Card Charged Subsequently (mm/yy):
Credit Card Authorization FormCredit Card Authorization Agreement • April 11th, 2019
Credit Card InformationCredit Card Authorization Agreement • February 1st, 2017
As cardholder or Corporate Officer, by signing below I understand and agree to the terms set forth in this agreement, agree to pay the monthly fee, and specifically authorize Buena Vista Recovery, LLC to charge my credit card for services provided to the above named client. I further agree that in the event my credit card becomes invalid, I will provide Buena Vista Recovery, LLC with a new valid credit card upon request, to be charged for the payment of any outstanding balances owed to Buena Vista Recovery, LLC.
JUNIUS LEARNING CENTERCredit Card Authorization Agreement • September 8th, 2020
I, hereby authorize Junius Learning Center to initiate automatic withdrawals from my account at the financial institution named below, every Monday for the amount mentioned on the Tuition Agreement. Further, I agree not to hold Junius Learning Center responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me, by my financial institution , or due to an error on the part of my financial institution in depositing funds to my account. This agreement will remain in effect until Junius Learning Center receives a written notice of cancellation from me or my financial institution.
E-TECH LLCCredit Card Authorization Agreement • March 30th, 2016
PLEASE READ THIS BEFORE YOU CONTINUE: FORM MUST BE COMPLETED IN FULL, SIGNED BY AN AUTHORIZED USER OF THE CREDIT CARD, SCANNED, AND EMAILED TO support@etechcorporation.com. IF YOU FAIL TO COMPLY WITH THESE REQUIREMENTS WE WON’T BE ABLE TO PROCESS YOUR ORDER.
Credit Card Authorization AgreementCredit Card Authorization Agreement • May 5th, 2020
and a confirmation number has been given. You must call the office with details to complete the booking. Thank you for reserving with Concorde Worldwide.
