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Automatic Credit Card Billing Authorization Form

This form is for automatic billing, simply complete the Credit Card Information section below and sign the form. All requested information is required. Upon approval, we will automatically bill your credit card for the amount indicated and your total charges will appear on your monthly credit card statement.

    Client Information


    Project Information


    Payment Information

    ​I authorize Bennett Creative Group to automatically bill the card listed below as specified: 

    Credit Card Information

    Security Code Located On The Back Of The Card

    Terms Of Agreement

    ​I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Bennett Creative Group (BCG) in writing of any changes in my account information or termination of this authorization at least 30 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.  I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an BCG Transaction being rejected for Non Sufficient Funds (NSF) I understand that BCG may at its discretion attempt to process the charge again within 30 days, and agree to an additional charge(s) for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the transactions to my account must comply with the provisions of U.S. law.  I certify that I am an authorized user of this credit card 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 this authorization form above. 
    Type Your Full Name
    Max file size: 20MB
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Phone | 919.670.5954
Email | info@bennettcreativegroup.com
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