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WITTY1® PRODUCTIONS, INC. AUTHORIZATION FOR CREDIT CARD PROCESSING
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NOTE:
In order for us to properly process your Credit Card, all
information must appear EXACTLY
as it does on your monthly Credit Card billing statement.
Thank you for your patronage!
DIRECTIONS:
1.) Print this page. CLICK HERE
to automatically print page. Printable version,
CLICK HERE.
2.) Complete all sections, printing clearly.
3.) Submit your completed Authorization Form by
Faxing to:
1.570.828.8889
or
Mailing
to:
Witty1® Productions, Inc. | RR2 Box 1155 - 103 Johnny Bee Rd | Dingmans Ferry | PA | 18328
Name: __________________________________________________________
Company: _______________________________________________________
Address: ________________________________________________________
City: ___________________________________________________________
State: _______________ Zip: _______________
Phone: _________________________________________________________
URL: ___________________________________________________________
Email: __________________________________________________________
Company Description / Type: _______________________________________
Card Type (YOU MUST CIRCLE ONE
)
American Express | Discover | MasterCard | Visa
Credit Card Number: ______________________________________________
3-4 Digit Verification Number: (on back of credit card) __________________
Expiration Date: _________________________________________________
Total Amount to be Billed: _________________________________________
I have read and agree with the Policy Statement of
Witty 1® Productions, Inc.,
as outlined
on their website: www.witty1.com. I hereby grant my permission and authorization for my
Credit Card to be billed in the amount set above for the following professional services:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Date: ______________ Signature: __________________________
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