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 submitted 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 or otherwise defined by Kala Marketing Group *
$
$
$
Today's Date *
Today's Date
Cardholder Name *
Cardholder Name
Phone
Phone
Address *
Address