2020-09-11_nadia_Credit card authorization form_HCA.docx

Credit Card Authorization Agreement

Authorization Agreement

I hereby authorize  to make credit card charges for the purchase of advertising on digital advertising and/or social media sites (i.e. Google, DV360, Facebook, Bing, Simpli.Fi, etc.), in the execution of HOME CARE ASSISTANCE MONTREAL advertising campaigns.

Payment receipts will be provided monthly.

This agreement will remain in effect until  receives a written notice of cancellation from me or an updated credit card authorization agreement to 20/eight DIGITAL Inc. is submitted.

ACCOUNT INFORMATION

Signature

*** All information provided will be held in the strictest of confidence and 
will not be shared with any 3rd parties.

¹A VISA or Mastercard is preferred as American Express is not accepted by many companies.

Card type¹ (Visa / Mastercard/AMEX):

16-digit credit card number: | Exp date: ____/_____

Name as written on card: | CVV # _____

Billing address for the CC:

Postal code   __________

Authorized Signature: | Date: