Credit Card Authorization form for coaches and consultants
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Credit Card Authorization Form for Coaches

 

Click Here to Download a Word version of the Credit Card Authorization Form

INSERT COACHES NAME OR BUSINESS NAME Credit Card Authorization

I, ___________________________, hereby authorize INSERT COACHES NAME dba INSERT COACHES BUSINESS NAME to charge to the following credit card account in the amount shown below for monthly coaching services.  This payment agreement will be in effect until services have been completed or are ended by request of the client either verbally or in writing. 

CREDIT CARD INFORMATION:

Card Type: (Circle One) Visa/Mastercard

Card Number:_______________________________________

Expiration Date: _____________________________________

Name on Card:_______________________________________

Billing Address:______________________________________
                                    Street or P.O. Box

                         _______________________________________
                          City,                              State                Zip Code

Amount: INSERT AMOUNT CHARGED
                       
Billing Cycle: INSERT HOW OFTEN YOU CHARGE

Cardholders Signature:__________________________________

 

Please complete form and fax to the following secure fax number: INSERT YOUR FAX NUMBER



 

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