Examples of Cardholder Name in a sentence
Option 1: Automated Credit Card Charge Card Type: Visa Mastercard Amex Discover Cardholder Name: Credit Card Number: Expiration Date: / Cardholder Signature: I authorize Operator to automatically charge my credit card on a recurring basis to pay any sums due from me for parking charges payable under my Agreement for Monthly Parking Privileges.
Xn Option 1: Automated Credit Card Charge Card Type: Visa Mastercard Amex Discover Cardholder Name: Credit Card Number: Expiration Date: / Cardholder Signature: I authorize Operator to automatically charge my credit card on a recurring basis to pay any sums due from me for parking charges payable under my Agreement for Monthly Parking Privileges.
Patient(s) Name(s): _ _ CHECK ONE: ____Checking Account Info: Name on Account: Bank Name: Account #: Routing #: ____Credit Card Info: Card Type: MasterCard Visa Discover Amex Cardholder Name: Billing Zip Code: Card #: Security Code: Expiration: / AUTHORIZATION I authorize Integrate Internal Medicine, P.C., to automatically bill the checking account or credit/debit card listed above, as specified.
Option 1: Automated Credit Card Charge Card Type: Visa Mastercard Amex Discover Cardholder Name: Credit Card Number: Expiration Date: / Cardholder Signature: Option 2: Bank Account Direct Withdrawal (E-Check) Bank Name: Transit Number: Account Number: Bank Address: Note: Please attach an unsigned check marked “VOID” I authorize Operator to automatically charge my credit card on a recurring basis to pay any sums due from me for parking charges payable under my Agreement for Monthly Parking Privileges.
Card #: Expiration: CVV Code: Zip Code: Cardholder Name: Volunteer/Chaperone: I wish to volunteer for this field trip.
Credit Card # Expiry Cardholder Name Signature I authorize CANASA to debit my credit card for the TOTAL dollar amount shown above.
Program Member either (i) tenders together with this Agreement the Member Amenities Fee, or (ii) hereby authorizes Personalized Care Practice’s designee to xxxx one-fourth (1/4) of the Member Amenities Fee (that is, $ ) per calendar quarter (3 months) payable in advance to Program Member’s: Cardholder Name Card Number Expiration Credit Card Zip Code Program Member understands that credit card payments will be processed by Signature MD, Inc.
Billing Address: Billing Phone: City, State, Zip: Email: Account Type: Visa MasterCard AMEX Discover Cardholder Name: Account Number: Expiration Date: (MM/YYYY) CVV2 Number: (3 digit number on back of Visa/MasterCard or 4 digits on front of AMEX) I authorize Studio Cellar LLC to charge the credit card indicated in this authorization form according to the terms outlined above.
Credit Card Type Cardholder Name Cardholder Signature I shall notify the Membership Office of the credit card information so that the Membership Office can input the information in the Club system.
Please circle the type of debit/credit card and complete the information below: Visa MasterCard Discover AmEx Cardholder Name: Billing Address: Card Number: Security Code: Expiration Date: I acknowledge receipt of a copy of the Membership Agreement, this Application, and the attached Required Comprehensive Disclosure Statement.