Credit Card Recurring Payment Authorization Form

  • Schedule your payments to be automatically charged to your credit card. Just complete and sign this form to get started!

    Recurring Payments Will Make Your Life Easier:

    • It’s convenient (saving you time and postage)
    • Your payment is always on time (even if you’re out of town), eliminating late charges
    • You can get Rewards Points for paying your bill

    Here’s How Recurring Payments Work: You authorize regularly scheduled charges to your Visa, MasterCard, American Express or Discover card. You will be charged each billing period for the total amount due for that period. A receipt will be emailed to you and the charge will appear on your credit card statement.

  • Please complete the information below:

  • I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the business in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. This payment authorization is for the type of bill indicated above. I certify that I am an authorized user of this credit card and that I will not dispute the scheduled payments with my credit card company provided the transactions correspond to the terms indicated in this authorization form.
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