Credit Card payment form
Cardholder name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Payment is being made for the following person
First Name
Last Name
Payment amount due:
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USD
Description
Credit Card
I hereby authorize Fast Action Bail Bonds to charge my credit card in the amount above for the purpose of posting bail for the above referenced client.I am providing a copy of my credit card and identification and I am submitting it to Fast Action Bail Bonds since I am unable to present the card in person.I agree not to dispute any charges or attempt any charge backs on the below listed card.
Cardholder signature
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