Credit Card Authorization

Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization
will remain in effect until canceled. It is the customer’s responsibility to keep a valid card on file. Please refer to
Service Agreement for terms and additional info. More details can be found on our website. Prepayment of minimum is applicable. Customer will be responsible for charges outside of minimum at completion of service visit. Declined cards will be noted on customer file, with all services suspended until all obligations are brought current. Customers will be responsible for any unpaid balances, including legal and collections fees.