Credit Card Payment Authorization

Date:___________________________

Assertive K-9 Training / Thinschmidt German Shepherds

11111 Spanish Hills Dr.

Corona, Ca. 92883

DEAR SIRS:

THIS LETTER IS TO CONFIRM MY UNDERSTANDING REGARDING PAYMENT OF ASSERTIVE K-9 TRAINING / THINSCHMIDT GERMAN SHEPHERDS.

YOU ARE HEREBY AUTHORIZED TO CHARGE MY CREDIT CARD FOR THE AMOUNT OF:

$_______________

_______________________________________________________________________________DOLLARS $ 00 CENTS

IT IS UNDERSTOOD THAT ALL CHARGES TO THIS CREDIT CARD ARE IRREVOCABLE AND NONREFUNDABLE.

MY CREDIT CARD INFORMATION IS AS FOLLOWS:

TYPE OF CREDIT CARD: □MC  □VISA  □CHECK CARD

Name of Issuing Bank:_________________________________________________

Account Number: _____________________________________________________

CVVC2 CODE: ________(3 digit number on back of card)

              The three digit code for Visa / MC on back of card 

Expiration Date: ________________________________________

Name as shown on card:___________________________________

Sincerely,

X______________________________________________________________
Client signature

PLEASE FAX TO: 951-277-4040