Credit Card Recurring Billing Authorization Form

Item# CCAFRM

Product Description

Credit Card Recurring Billing Authorization Form

Terms

I hereby authorize USPsychic.com a division of Medieval Masters LLC., to charge my credit card as listed below for ongoing Retainer Services provided. I understand that this is a periodic charge that will be made to my credit card without any further action on my part. I may cancel at any time in accordance with the procedures listed below. I understand that I will receieve a receipt of purchase with every payment made as well as one FREE email consultation each week with the services I am hiring USPsychic.com to perform for me.

Automatic Withdrawal Schedule

Weekly, automatic withdrawal for services provided will be each Friday of each week (4-5 times per month, more or less depending on the amount of days in the month, in the amount of $1,750.00 each Friday.

Cancellation Of Authorization

In order to cancel this authorization with respect to any future charges not already made, the cancellation form n your payment page must be submitted to cancel this authorization. Submission of cancellation must be given at least four (4) days prior to the date the next charge to your credit card would be made.

agree and understand Credit Card Terms

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All Fields Must be Filled-Out For Automatic Withdrawal Acceptance:

*All fields must be filled out to be accepted.

*First & Last Name as Appears on Signature Field of Credit Card:

*Cardholder Phone Number:

*16 Digit Credit Card Number:

*Expiration Date:

*Three Digit Security Code on The Back of The Card:               

*Issuing Bank Name as Appears on The Credit Card:


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Credit Card Billing Address:


Address:   

Apt/Suite:


City:


State:

Country:


Zip:


   


All information is completely confidential.
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