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Credit Card Payment Authorization

Card Holder*

Email Address*

ID No. & State*

Phone*

Complete Address (incl. City, State, Zip)*

Card No.*

Card Type*

Card Expiration Date

3-Digit Code*

Business Name

Are You Making A Payment For Yourself OR Someone Else?*

Description of Product Or Service*

Amount To Charge*

There Will Be A $3.00 minimum OR 3% Card Fee, whichever is greater*

Select an option

Payment Type*

If Setting Up Recurring Payments, What Date Of Each Month Would You Like Your Card To Be Charged

Your Mothers Maiden Name?*

You Are Authorizing One Accord Tax & Business Services To Withdraw The Amount Listed Above, Plus The Appropriate Card Fee. *

Todays Date*

Important Information:

Your Credit Card Payment Will Be Processed Upon Receiving This Authorization Request.  Please Make Sure You Are The Legal Authorized User And  All Card Information Is Correct.  Any Fraudulent  Activity Will Be Reported To The Financial Institution, & Law Enforcement.  If  This Is Not Your Card or You Are Not  An Authorized User,  Do Not Proceed With This Financial Transaction.

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