Recurring Credit Card Authorization Form

Recurring Credit Card Authorization Form
I authorize regulary scheduled charges to my card on the on the remaining balance of my order for the additional payments required, every week, starting 1 week or month from the date of purchase, until complete.

These terms will be provided with my online reciept provided by the company upon payment of your first payment at completion of your order.

You agree that no prior-notification will be provided unless the date or amount changes.

I likewise certify that I am the authorized user of the Credit Card that shall be submitted through this form. As long as the transactions correspond to the terms and conditions indicated in this authorization, I shall not raise disputes against the company.

All failed credit card charges declined and not rectified within 24 business hours will be charged a $35 fee. Three failed attempts will result in the cancellation of your payment plan and will require a $100 reinstatement fee to a recurring payment plan. Until payments are resumed, no course access, books shipped, or the ability to return any materials will be allowed.

"By signing this, you agree that you cannot cancel your order."
Name*

First NameLast Name
Enter your Order Number*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
The entry of your credit card details will be stored until the payment plan is complete. Entering your payment information will not immediately charge your card. Your card will only be charged on your payment plan schedule.

My Products*

USDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code

Drivers License Number and State*
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: