Credit Card Authorization Form

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Please enter your card billing details below.

Name
First Last
Billing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company
Phone
Email
Type of Credit Card
- Visa
- MasterCard
- AmEx
- Discover
Card Details
Card # CVV Code
Exp Date
Expiration Date Amount
Payment Interval
- 1-Time
- Monthly
- Annually
Consent
I hereby authorize the P3 Agency to bill my credit card at the above amount and interval.
Payment in full to be made upon completion of installation, unless otherwise noted. A finance charge of 1.5% (per annum) will be charged to accounts past 30 days. In the event the customer defaults under the terms of the agreement, customer agrees to pay all costs of collection associated with collecting the amount owed, including reasonable attorney fees.
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