Minds Over Marketing Terms: Credit Card Authorization

Credit Card Authorization

Thank you for choosing Minds Over Marketing. The following form authorizes
us to process your invoices according to the terms of your project agreement.

Please enter the required information on this web page, then print, sign and
fax to 818-332-5087. The information on this form will NOT be digitally saved,
ensuring your privacy and security.

Credit Card:
Visa MasterCard American Express Discover

Company/Organization:

Cardholder Name:

Credit Card Number:

Security Code:

Expiration Date:

.....

Billing Address

City:

State:
Zip:

Telephone:

E-Mail:

Cardholder Signature:

Ensuring your privacy and security,
please print and fax this completed form to 818-332-5087