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credit card authorization form

Thank you for your business.

 
 
Please Include Legal Company Name. Ex, Black Square Group / Black Square Trading Group LLC.
Name on Credit Card *
Name on Credit Card
Please Use Only Numeric Values
Please Use Only Numeric Values. Ex. 0221
Please Use Only Numeric Values. Security Number/Code 3 or 4 Digits
Billing Address *
Billing Address
Please Utilize Commas and Decimals. Ex. $10,000.00
$
Disclaimer *
Credit Card processing fee (5%) applies on all transactions. In case of unauthorized cancellation an extra fee of $500.00 USD will be charged to the next invoice. The amount does not include tax if applicable. All transactions are final and non refundable. E-contracts and E-signatures are just as legal and enforceable as traditional paper contracts signed in ink. Federal legislation enacted in 2000, known as Electronic Signatures in Global International Commerce Act (ESGICA). All charges will appear from Black Square Trading Group LLC and/or Black Square Group.
Name and Initials
Invoice Number and/or Services Provided. In case of being a retainer, please state the term MONTHLY RETAINER and length, Ex. "MONTHLY RETAINER 6 MONTHS"