You authorize regularly scheduled charges to your credit card. You will be charged the amount indicated below each billing period. A receipt for each payment will be provided to you and the charge will appear on your credit card statement. You agree that no prior-notification will be provided unless the amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.I First Name* Last Name* authorize ETO Martial Arts & Fitness to charge my Credit/Debit Card indicated below for $Monthly Fee Amount* between the 5th - 12th day each month.
Billing InformationStreet Address Address Line 2 City State Zip Email Phone Number Card Details Visa MasterCard Discover American Express Cardholder Name Type a label Card Number Type a label Expiration Date Type a label CVV Type a label Zip Code Type a label
I First Name* Last Name* understand that this authorization will remain in effect until I cancel it, and I agree to notify ETO Martial Arts & Fitness in writing of any changes in my account information or termination of this authorization at least one months prior to the next billing date. I acknowledge that the origination of Credit Card transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this Credit Card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this authorization form.