Fill Out Form

Credit Card Authorization Form

For Services from Ambuul Marketing
Cardholder Name

First NameLast Name

Payment Stuctures*

One-Time Payment of $250($250.00 one-time payment)

By making just one payment of $250, you are entitled to $50 off the total advertising cost. Total cost is $250 instead of $300.

Two Payments ($50 Up Front, $250 Later)($50.00 for the first month then,$250.00 for each month)

If you choose to make two payments, the first will be a down-payment of $50. This is the setup cost to run the advertisement. The second charge is $250.00, and will occur either (1) After an employee is hired and completes one full week of work, or (2) after 30 days have passed; whichever comes first.

Payment Method
Credit	Express

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

ConditionText
Date

MonthDayYear
I, {cardholderName}, as a cardholder, hereby authorize Ambuul Marketing to charge my credit card for {conditiontext} and confirm that the information for the credit card and billing address is complete and accurate. I have been informed that I can cancel the recurring payment at least 15 days before the payment by phone or signing a consent form provided by the merchant company.
Payment Authorization & Service Agreement*
Cardholder Signature

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Credit Card Authorization Form