Payment Authorization Payment Authorization Payment Authorization Credit Card Payment (includes 3% fee added to invoice) AMEX Visa Mastercard DiscoverCardholder Name Card Number Please Re-Enter Card Number for Verification Expiration Date Billing Zip Code ACH Bank Transfer Payment (includes 1% fee added to invoice) Checking Account Savings AccountBank Routing Number Please Re-Enter Bank Routing Number for Verification Account Number Please Re-Enter Account Number for Verification Recurring 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: Certification Name Today's Date Submit Form