Recurring Credit Card Payment Authorization Form

Complete and sign this form to authorize the “Support for Students Growth Center” to make charges to your credit card listed below.

By signing this form you give us permission to charge your credit card for services incurred and does not provide authorization for any additional unrelated devits or credits to your account without your consent.

Paid invoices will be emailed to authorized email account after each, weekly, billing.

Recurring Credit Card Payment Authorization Form
I authorize the "Support for Students Growth Center" to charge my credit card account below for various services_on or after 01/28/2020.
Billing Address *
Billing Address

Card Information

Checkboxes *
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above for the amount indicated above only and is valid for as long as services are provided. I certify that I am an authorized user of this credit card and that I will not dispute payment with my credit card company so long as the transaction corresponds to the terms indicated in this form.