Recurring CC Authorization

Cardholder Name *
Cardholder Name
Billing Address *
Billing Address
Phone *
Phone
Credit Card Type
Visa, MasterCard, and Discover - 3 Digit Code on Back of Card Amex - 4 Digit Code
I authorize Salon Partners, LLC to charge the agreed amount listed below to my credit card provided herein on the agreed upon date/ dates listed below. I agree that I will pay for this purchase in accordance with the issuing bank cardholder agreement. I understand that this authorization will remain in effect until my balance is paid in full. In addition, I agree to notify Salon Partners, LLC of any changes to my payment information at least 10 days prior to the next payment authorization period. (billing date). I am the authorized user of this payment card and will not dispute the scheduled payments outlined above.
Date *
Date
Approved By:
Approved By: