The power move project™

recurring Payment Authorization form

Here’s How Recurring Payments Work:

You authorize regularly scheduled charges to your checking/savings account or credit card.  You will be charged the amount indicated below on each billing date.  A receipt for each payment will be emailed to you and the charge will appear on your bank statement. You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 5 days prior to the payment being collected.


Name *
Name
Best Phone Number to Reach You *
Best Phone Number to Reach You
Billing Address *
Billing Address
Credit Card
Please select your payment plan *
Card Holder Name *
Card Holder Name
Expiration Date *
Expiration Date
*
*