Credit Card Authorization Form For Monthly Customers

Credit Card Authorization Form For Monthly Customers
I {input18:1}, as a cardholder, hereby authorize Valet King to charge my credit card for {conditiontext} and confirm that the information for the credit card and billing address is complete and accurate. I have been informed that I can cancel the recurring payment at least 15 days before the payment by phone or signing a consent form provided by the merchant company.
Cardholder Signature*

Clear

My Products

1QPS Monthly Parking (Sedan)$400.00

1QPS Monthly Parking (SUV)$450.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country