Credit Card Authorization Form

Credit Card Authorization Form
Cardholder Name

First NameLast Name
ConditionText
I, {cardholderName}, as a cardholder, hereby authorize MODEL MAFIA LLC to charge my credit card for {conditiontext} and confirm that the information for the credit card and billing address is complete and accurate.
Date

MonthDayYear
Date
Cardholder Signature

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My Products
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One Time Payment
$4,000.00

Monthly Payment
$2,500.00
Should be Empty: