Carpenters Local #277 recurring dues

Carpenters Local #277

Credit Card Recurring Payment Authorization Form
Recurring Payments Will Make Your Life Easier:

1: It’s convenient (saving you time and postage) 2: Your payment is always on time (even if you’re out of town), eliminating late charges
Here’s How Recurring Payments Work:

You authorize regularly scheduled charges to your Visa, MasterCard, American Express or Discover card. You will be charged each billing period for the total amount due for that period. A receipt will be emailed to you and the charge will appear on your credit card statement. You agree that no prior-notification will be provided if the total payment is under . If your bill is more than that amount, or the payment date changes, you will receive notice from us at least 10 days prior to the payment being collected.
Please complete the information below:
Name*

First NameLast Name
I authorize Carpenters Local#277 to charge my credit card indicated below on the (day) of each (month) for my monthly dues. You pick the day of the month.
I understand that I will only receive advance notice of the charge if it exceeds your monthly payment. Please put in your monthly dues amount. Regular member is $21.00 per month.
Month
Phone*
Format: (000) 000-0000.
Email*
example@example.com
Account Type*

VisaMasterCardAmexDiscover

Recurring Dues*

Monthly Dues

Monthly dues payment of $21.00 per month will automatically be deducted from your checking account on the 1st week of month.

$21.00 Quantity
Item subtotal:$0.00

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

Signature*
DATE SUBMITTED*

MonthDayYear
Date
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the business in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. This payment authorization is for the type of bill indicated above. I certify that I am an authorized user of this credit card and that I will not dispute the scheduled payments with my credit card company provided the transactions correspond to the terms indicated in this authorization form.

CC Authorizatin Recurring Payment
Should be Empty:

Carpenters Local #277