credit card authorization

This credit card authorization form acts as authorization for deposits and remaining balance, and/or monthly service fees, as guarantee of payment. Kala Marketing Group, LLC. requires that this form be completed and returned before the start of services. By signing this form you give us permission to debit your account for the amount indicated and agree to pay for this purchase in accordance with the issuing bank cardholder agreement.


 
I hereby authorize payment as defined in my Suggested Marketing Fee Schedule
$
$
$
I hereby authorize MONTHLY payment as defined by my Social Media Plan
Today's Date *
Today's Date
Cardholder Name *
Cardholder Name
Phone
Phone
Address *
Address