WMC CREATIVE CREDIT CARD AUTHORIZATION FORM

Name

First Name

Last Name

Cardholder's Name

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Credit Card Type

Visa

Mastercard

Discover

American Express

Credit Card Number

Expiration Date

Card Identification Number

Last 3 digits located on the back of the credit card

Amount to Charge ($USD)

I authorize WMC CREATIVE to charge the agreed amount listed above to my credit card provided herein. I agree that I will pay for this purchase in accordance with the issuing bank cardholder agreement. Staff and/or performance overages will be billed by 30-minute increments of rate when occurred.

Notes: 3.8% processing fee to be added to all CC payments.

Date

YYYY