Credit Card Payment Form
Please click the word icon at the bottom of the page for a dowloadable form, or copy, print, and fill out the form below and drop it off at our office in Hudson.
Credit Card Authorization Form
Type of Card: Visa_____ MasterCard_____Discover_____
Credit Card # :_____________________________________________
Exp Date: __________/__________
Please pay and charge my credit card account and all drafts by Seabreeze Pest Control, Inc. in its own order after each service has been rendered.
This authorization will remain in effect until cancelled by me in writing, and until you actually receive such notice. I agree that you shall be fully protected in honoring any such draft.
I agree that treatment of each draft and your rights in respects to do it, shall be the same as if it were signed by.
Call before processing: Yes____ No_____
Via-Phone: Yes_____ No_____
Monthly Processing: Yes_____No_____
Date:_____/_____ Date Revised:_____/_____