RECURRING CREDIT CARD AUTHORIZION FORM

RECURRING CREDIT CARD AUTHORIZION FORM
Here's How Recurring Payments Work:
You authorize regularly scheduled charges to your Visa, MasterCard, American Express, or Discover card. You will be charged the amount indicated below for each billing period. Each amount charged will appear on your credit card or checking account statement. A receipt will be sent to you by email or mailed through the US Postal Service. You agree that this authorization will serve as your notification and no prior-notification will be provided unless the payment due date or installment payment amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.
Please complete the information below:
Principal Defendant Name

First NameLast Name
Premium amount owed ($
I, First Name* Last Name* authorize Tennessee Bonding Company to charge my credit card $ * (payment amount) to be charged on a (Weekly Biweekly Monthly Bimonthly* ) cycle.
Payments begin on this date:

MonthDayYear
and continue, until paid in full, to the card ending with:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #:
Format: (000) 000-0000.
E-Mail:
example@example.com
SIGNATURE
DATE

MonthDayYear
Date
Authorization

I authorize A 24/7 BAIL BONDING to charge my credit card that is indicated in this authorization form according to the terms outlined above. Iunderstand that this authorization will remain in full force and effect until A 24/7 BAIL BONDING received written notification from me, and Iagree to notify A 24/7 BAIL BONDING in writing of any changes in my account information or termination of this authorization at least 7days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may beexecuted on the next business day. This payment authorization is for bail bond premium owed in the amount indicated above. J certify that Iam an authorized user of this credit card and that I will not dispute the payment with my credit card company; provided the transactionscorrespond to the terms indicated in this authorization form.
Should be Empty:

RECURRING CREDIT CARD AUTHORIZION FORM

Here's How Recurring Payments Work:

Please complete the information below: