The Orinda News Advertiser Recurring Payment Form

The Orinda News Advertiser Recurring Payment Form

Please fill out this form to arrange for automatic payment of your monthly invoice for ads placed in The Orinda News
Advertiser Name*

First NameLast Name
Company Name*
Enter your company name, if personal ad enter last name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Advertiser Representative*

Jill GelsterElana O'LoskeyKathy EnzerinkTrish WardDon't Know

Advertiser Recurring Monthly Payment $(USD for each month)

Please enter the amount of your monthly ad payment in The Orinda News. You credit card will be automatically charged each month for that amount.

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

Please check box below:*

I understand that by submitting this form my credit card will be billed automatically each month for the amount I have entered for the newspaper ad in The Orinda News. I also understand that in the event I want to change or cancel the recurring payments, I must notify the Orinda Association in writing at least 14 days prior to the payment date.
Signature*

Clear
Please sign here
Should be Empty: