Advantage
 

Pre-Authorization Payment Agreement for Credit Card Changes

Name exactly as it appears on card: ____________________________________

Billing address of cardholder:  _________________________________________

City: ____________________ State: __________Zip: _____________

Phone(s): _______________________________________

Email:  _________________________________________

Card type Visa/MasterCard: __________________________

Credit card number: _____________-_____________-_____________-_____________

Expiration Date: _______/_______

(The last 3 or 4 digit code on back of credit card): _____________

I, hereby authorize Advantage to charge my credit card in consideration for the advertisement(s), I have placed with them. I understand and agree that this authorization is in lieu of my signature on an actual charge draft or carbon copy voucher.

I authorize a total amount of $_____________ per month, or $_____________ quarterly until such time I discontinue my advertising by notifying publisher in writing.

I further understand that there will be no refunds to my credit card, and all ad sales are final.

Card Holder Signature: _______________________________________

Please FAX to 714-206-6909
Or scan and email to staff@usfinestescorts.com

(Office Use Only)

City: _______________ Category: ____________ Name: __________________

Phone: __________________________ Email: __________________________

Date: ___-___-___   Authorization:  ________________________________