credit card authorization & automatic payment processing
CREDIT CARD AUTHORIZATION & AUTOMATIC PAYMENT PROCESSING Please fill out and fax the following to Massage Advantage Corporate for Credit Card Authorization & Automatic Payment Processing. You may call your card number in, but you must still fax this document with your authorization and last 4 digits of the card number.
Business/Clinic Name: Credit Card Number:
Type of Card:
Expiration:
CVC Code on Back:
Billing Address for Card:
Card Holder’s Printed Name: Signature:
Date:
Card Holder’s Signature authorizes Massage Advantage, Inc. to automatically charge this credit card for orders placed by a clinic staff member/owner once Massage Advantage receives their proof approval and an e-mail notification is sent to a clinic staff member or owner. Effective as of date above.
Fax to: Massage Advantage Corporate Attention: Accounts Receivables Fax Number: (501) 492-2822 P O Box 8167, Jacksonville, AR 72078 Phone Number: (866) 949-2112 From: Fax number: Number of Pages: When will I be charged? Once proof approval is received on a project, you will be notified via e-mail of the total amount to be charged and the items being charged for. Your confirmation-reply is not required for the charge to be made. What orders will be charged on this credit card? All orders on account thru Massage Advantage will be charged, unless a vendor bills the clinic directly. Can I get a receipt? You will receive a detailed invoice marked paid once payment is processed, as well as a credit card receipt. Is there an alternative payment method? Yes, you can mail a check to Massage Advantage Corporate PO Box 13241, Maumelle, AR 72113, however this will delay your order being processed until the check arrives and is cleared.
Massage Advantage, Inc. - P.O. Box 8167, Jacksonville, AR 72078 – 866-949-2112, Option 3
CREDIT CARD AUTHORIZATION & AUTOMATIC PAYMENT PROCESSING This authorizes MASSAGE ADVANTAGE (the “Company”) to send credit entries (and appropriate debit and adjustment entries), electronically or by any other commercially accepted method, to my (our) account(s) indicated below and to other accounts I (we) identify in the future (the “Account”). This authorizes the financial institution holding the Account to post all such entries. Account Information: (check one):
Checking
Savings
Bank Name: Bank Routing # (ABA#): Bank Account #: This authorization will be in effect until the Company receives a written termination notice from myself and has a reasonable opportunity to act on it. Signature: Printed Name: Date:
Massage Advantage, Inc. - P.O. Box 8167, Jacksonville, AR 72078 – 866-949-2112, Option 3
Business/Clinic Name: Credit Card Number:
Type of Card:
Expiration:
CVC Code on Back:
Billing Address for Card:
Card Holder’s Printed Name: Signature:
Date:
Card Holder’s Signature authorizes Massage Advantage, Inc. to automatically charge this credit card for orders placed by a clinic staff member/owner once Massage Advantage receives their proof approval and an e-mail notification is sent to a clinic staff member or owner. Effective as of date above.
Fax to: Massage Advantage Corporate Attention: Accounts Receivables Fax Number: (501) 492-2822 P O Box 8167, Jacksonville, AR 72078 Phone Number: (866) 949-2112 From: Fax number: Number of Pages: When will I be charged? Once proof approval is received on a project, you will be notified via e-mail of the total amount to be charged and the items being charged for. Your confirmation-reply is not required for the charge to be made. What orders will be charged on this credit card? All orders on account thru Massage Advantage will be charged, unless a vendor bills the clinic directly. Can I get a receipt? You will receive a detailed invoice marked paid once payment is processed, as well as a credit card receipt. Is there an alternative payment method? Yes, you can mail a check to Massage Advantage Corporate PO Box 13241, Maumelle, AR 72113, however this will delay your order being processed until the check arrives and is cleared.
Massage Advantage, Inc. - P.O. Box 8167, Jacksonville, AR 72078 – 866-949-2112, Option 3
CREDIT CARD AUTHORIZATION & AUTOMATIC PAYMENT PROCESSING This authorizes MASSAGE ADVANTAGE (the “Company”) to send credit entries (and appropriate debit and adjustment entries), electronically or by any other commercially accepted method, to my (our) account(s) indicated below and to other accounts I (we) identify in the future (the “Account”). This authorizes the financial institution holding the Account to post all such entries. Account Information: (check one):
Checking
Savings
Bank Name: Bank Routing # (ABA#): Bank Account #: This authorization will be in effect until the Company receives a written termination notice from myself and has a reasonable opportunity to act on it. Signature: Printed Name: Date:
Massage Advantage, Inc. - P.O. Box 8167, Jacksonville, AR 72078 – 866-949-2112, Option 3
