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CC Authorization Template

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Alfonso Joel V. Gonzales

This document is a credit card authorization form for legal services provided by the Law Offices of Vincent W Davis & Associates. It provides details for charging Brett Brashears' credit card, including the card number, expiration date, billing address, and an initial down payment of $2,500. It authorizes recurring monthly charges and additional charges as needed. The form also outlines cancellation policies, including non-refundable authorization cancellation via certified mail or if legal services have already been provided. By signing, the client confirms understanding and acceptance of the credit card and cancellation terms.

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© All Rights Reserved
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CC Authorization Template

Uploaded by

Alfonso Joel V. Gonzales
233 views1 page
This document is a credit card authorization form for legal services provided by the Law Offices of Vincent W Davis & Associates. It provides details for charging Brett Brashears' credit card, including the card number, expiration date, billing address, and an initial down payment of $2,500. It authorizes recurring monthly charges and additional charges as needed. The form also outlines cancellation policies, including non-refundable authorization cancellation via certified mail or if legal services have already been provided. By signing, the client confirms understanding and acceptance of the credit card and cancellation terms.

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Cc Authorization Template - Copy

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This document is a credit card authorization form for legal services provided by the Law Offices of Vincent W Davis & Associates. It provides details for charging Brett Brashears' credit card, including the card number, expiration date, billing address, and an initial down payment of $2,500. It authorizes recurring monthly charges and additional charges as needed. The form also outlines cancellation policies, including non-refundable authorization cancellation via certified mail or if legal services have already been provided. By signing, the client confirms understanding and acceptance of the credit card and cancellation terms.

Copyright:

© All Rights Reserved
Download as DOCX, PDF, TXT or read online from Scribd
Download as docx, pdf, or txt
233 views1 page

CC Authorization Template

Uploaded by

Alfonso Joel V. Gonzales
This document is a credit card authorization form for legal services provided by the Law Offices of Vincent W Davis & Associates. It provides details for charging Brett Brashears' credit card, including the card number, expiration date, billing address, and an initial down payment of $2,500. It authorizes recurring monthly charges and additional charges as needed. The form also outlines cancellation policies, including non-refundable authorization cancellation via certified mail or if legal services have already been provided. By signing, the client confirms understanding and acceptance of the credit card and cancellation terms.

Copyright:

© All Rights Reserved
Download as DOCX, PDF, TXT or read online from Scribd
Download as docx, pdf, or txt
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LAW OFFICES OF VINCENT W DAVIS & ASSOCIATES 150 NORTH SANTA ANITA AVENUE, SUITE 200;

ARCADIA, CALIFORNIA 91006 626 446 6442 (T) 626 446 6454 (F)

WWW.VINCENTWDAVIS.COM

Credit Card/Debit Card Authorization Form and Cancellation Policy

I, the undersigned, authorize my credit card to be charged for legal services requested and/or rendered as indicated:

Client Name: Brett Brashears

Cardholder Name: Brett Brashears

Card Billing Address: ___________________________________ City ___________ State _____ Zip Code_____

Card #: __________________________________________________Exp. Date _____ /____Security Code:_____

Card Type: ___Visa; ___ MC; ___ AMEX; ___Discover Charge Type: ____Credit Card or ____Debit Card

Amount to be charged for down Payment: $2,500.00. Amount to be charged per Frequency:

Charge Frequency: ____ Once; ___ Weekly; ___ Biweekly; ___ Monthly; ____ Other:

Date(s) to Charge: _________

Authorization Policy: I authorize the Law Offices of Vincent W Davis & Associates ("Davis") to charge my
credit/debit card on a single, multiple, or recurring monthly basis, as indicated above. I authorize Davis to keep my
credit card information on file to charge for additional amounts due in the future whenever I provide written or oral
authorization to do so, or in the event that I fail to pay any invoice by the due date. I understand that although a
particular date to charge may be selected that the card may be ran on another date if it is unable to be charged on the
date indicated. I understand that although a particular amount to be charged may be selected, that the card may be
charged for a different amount if the card is unable to be charged for that amount indicated. I agree that a 3.5%
credit/debit card processing fee may be added at the discretion of Davis. I agree that this credit card authorization
will remain in effect until my legal matter is resolved and until my final invoice is paid in full.
Cancellation Policy: I agree that the following types of credit/debit card authorizations are non-refundable and non-
cancellable:
(a) Written credit/debit card authorization cancellation request via certified mail return receipt, (b) Signed
Substitution of Attorney Form to release Davis of the obligation to continue providing services, (c) Payment of past
due amount for legal services already performed - as indicated in an Invoice. (d) Payment of a 20% cancellation fee
of the amount authorized under this form - to compensate Davis for the lost revenue due to set aside time could have
offered to other clients, and for the credit card processing and cancellation costs.
I confirm that I have read, understand, and accept the conditions of Davis credit/debit card authorization and
cancellation’s policy. I have received all legal services paid for under this credit card authorization to satisfactory
conditions. Davis credit/debit card processor may require an imprint/photocopy of the card to be attached to this
form and I agree that I have supplied a copy of the card now and will in the future upon demand to a credit card
processor.

Date Signed: ________________________ Signature of Card Holder: _________________________________

COPY OR IMPRINT OF CREDIT OR DEBIT CARD HERE

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