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TRANSACTION DETAILS
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CARD DETAILS

TERMS AND CONDITIONS

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. If paying via ACH/check, then by authorizing this transaction, customer agrees to convert this transaction into an Electronic Funds Transfer (EFT) via ACH transaction and to debit this bank account for the amount specified.