Payment Authorization Payment Authorization Payment AuthorizationCredit Card Payment (includes 3% fee added to invoice) AMEX Visa Mastercard DiscoverCardholder NameCard NumberPlease Re-Enter Card Number for VerificationExpiration DateBilling AddressAddress Line 1Address Line 2CityStateZip CodeACH Bank Transfer Payment (includes 1% fee added to invoice) Checking Account Savings AccountBank Routing NumberPlease Re-Enter Bank Routing Number for VerificationAccount NumberPlease Re-Enter Account Number for VerificationRecurring Payments Weekly (charged on Monday or Tuesday for previous week's service) Monthly (charged on the 1st-5th of each month)Email receipts and/or monthly statements to:CertificationNameToday's DateSubmit Form90339