Card Authorization

Card Authorization

Card holder Name*
First Last
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company*
Email*
Phone
Card Type*
Card Number*
Expiration Date*

Please enter as MM/YY format
CVC Number*

Please enter CVC from the back of the card
Authorization*
- I hereby authorize Axis Software Dynamics to charge my credit card indicated above per our contract. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in our contract.
Disclaimer*
- I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Axis Software Dynamics in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day.
Signature*
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.

.