Skip to content
Home
About Us
Our Services
Branding
Geo Fence Ads
Google Ads
Social Media Ads
Web Design
Get Started
Blog
Contact
Home
About Us
Our Services
Branding
Geo Fence Ads
Google Ads
Social Media Ads
Web Design
Get Started
Blog
Contact
GET STARTED
Credit or Debit Card Monthly Authorization Form
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Cardholder Name
*
First
Last
Cardholder Email
*
Cardholder Phone
Amount Information Name
Billing Address
*
Credit Card Information
*
Authorized Charge Amount
Price:
$721.00
Authorization Date
*
Authorization Terms
*
I authorize Choice Digital Media to charge the credit card listed above in the monthly amount of $700 plus a 3% processing fee ($21). These charges will occur automatically each month and this authorization will remain in effect until cancelled in writing with a minimum 30-day notice. I understand that any declined or failed payments may result in services and advertising campaigns being paused, a late payment fee of $50 may apply, and that monthly service fees are strictly non-refundable.
Cardholder Signature
*
Clear Signature
Authorize Payment
