Form | Artic Designs, Inc. | Web Design | Web Hosting | Atlanta Georgia

ARTICDESIGNS

P.O. Box 44191 Atlanta, GA 30336-1191 | Phone: 404.213.4991 | Fax: 877.389.4701

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Credit Card Billing Authorization Form

If you would like to enjoy the convenience of automatic billing, simply complete the Credit Card information section below and sign the form. All requested information is required.
Upon approval, we will automatically bill your card for the amount indicated and your total charges will appear on your monthly credit card statement. You may cancel this automatic billing authorization at any time by contacting us at billing@articdesigns.com

Please Complete The Below:

Customer Name:

Phone Number:

Email Address:

I authorize ARTIC DESIGNS, INC. to bill the card listed below as specified:

Amount:

Frequency: Weekly, Monthly, Quarterly or Anually:

Start billing on:

ARTIC DESIGNS, INC. accepts the following credit cards: VISA, MasterCard, DISCOVER, and American Express:

Name as it appears on the card:

Credit Card Type:

(Ex: VISA, MasterCard, Etc?)

Credit Card Number:

Expiration Date:

Mailing address where you get your credit statement:

CCV# on the back of the Card (Three Digits):

Customer Signature:

Clear Signature

Today's Date: