CREDIT CARD AUTHORIZATION FORM CREDIT CARD PAYMENT AUTHORIZATION FORM * Complete this electronic form to authorize RBM Consultations and Services DBA Let Hunny Know Inc. to make a debit to your credit card listed below for the services agreed upon in our contract. By signing this form, you give us permission to debit your account for the amount indicated on your service agreement, and/or recurring charges for third-party services that you signed up for. You will be charged on the specified dates that the recurring services indicate through your website vendor, and/or your subscription plan that was chosen. This is permitted only for the transactions specified in our contract agreement, or addendums that are attached. It does not provide authorization for any additional unrelated debits or credits to your account. YOUR NAME * First Name Last Name BUSINESS/ ORGANIZATION NAME * DESCRIPTION OF SERVICES * Select all services that apply Website - Squarespace Website - Shopify Website - Wix Website - GoDaddy Website - Other/ Maintenance Third Party - Cognito Forms Third Party - CRM Services Branding & Marketing Campaign Other Services Not Listed BILLING ADDRESS * Address 1 Address 2 City State/Province Zip/Postal Code Country PHONE * Country (###) ### #### EMAIL * NAME ON CARD * First Name Last Name ACCOUNT TYPE: * Amex Discover Mastercard Visa ACCOUNT#/ CARD# * EXPIRATION DATE * CVV * 3 digit number on the back of Visa/MC, 4 digits on front of AMEX TYPE YOUR NAME - SERVES AS ELECTRONIC SIGNATURE * DISCLAIMER * I authorize the above name business to charge the credit card indicated in this authorization form according to the terms outlines above, and in our contract services agreement. This payment and any reccuring payments is for goods/services indicated above, and/or in our contract service agreement only. I certify that I am an authorized user on this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. DATE * TODAYS DATE GOES HERE MM DD YYYY Thank you for your feedback. We look forward to working with you! Let Hunny Know and Team!
