Bailey Business Services, Inc.
Providing Business & Office Support?Virtually
1933 Highway 35 -- Suite 105-295
Wall, NJ 07719-3502
732-840-2198 office
732-206-0862 fax
www.BaileyBusinessServices.com
This credit card authorization form gives Bailey Business Services, Inc. the authority to charges services provided to your credit card.
Your signature confirms agreement to charge $____________ to your credit card.
Name (as it appears on credit card):___________________________________________
Credit Card #:______________________________ Expiration Date: _______________
Credit Card Type: ( ) Visa ( ) Master Card ( ) AMEX
CCV #: ______________ (the 3-digit number on the back of the credit card)
Amount to be charged: $_________________ ( ) Initial Payment
( ) Retainer Payment
( ) Account Balance -- Invoice #_________
Business Name: __________________________________________________________
Business Contact: _________________________________________________________
Billing Address: ___________________________________________________________
__________________________________________________________
Phone Number: ___________ Fax Number: ____________ Cell Number: ______________
Please complete and fax this form to:
Bailey Business Services, Inc.
Fax: 732-206-0862
Phone: 732-840-2198
OR
Mail this form to:
Bailey Business Services, Inc.
1933 Highway 35 -- Suite 105-295
Wall, NJ 07719-3502
NOTE: You also have a call-in option. Please call Bailey Business Services, Inc. and provide this information. When this information is called in, this form will be completed and dated indicating your verbal approval of the charges and a copy of the form will be put on file and sent to you as verification.
Signature: ___________________________________ Date: _________________________
|