Payment Authorizations — Elite Educator

One-Time Credit Card Authorization Payment

Sign and complete this form to authorize Elite Educator, LLC to make a one time debit to your credit card listed below OR Click the button below to Download and Print the Authorization Form. By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

Click here to download and print One-Time Credit Card Authorization

Name

First Name

Last Name

Email

Phone

(###)

###

####

Amount You Are Authorizing for this One-Time Payment

$

On or After This Date

MM

DD

YYYY

Reason for the Payment

Credit Card Information

Card Holder Name

First Name

Last Name

Credit Card Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Credit Card Type

VISA

Mastercard

AMEX

Discover

Credit Card Number

Expiration Date

CVV

By typing my name here, I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Today's Date

MM

DD

YYYY

Recurring Credit Card Authorization

Sign and complete this form to authorize Elite Educator, LLC to make a one time debit to your credit card listed below OR Click the button below to Download and Print the Authorization Form. By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for recurring payments.

Click here to download and print Recurring Credit Card Authorization

Name

First Name

Last Name

Email

Phone

(###)

###

####

Amount You Are Authorizing for Recurring Payments

$

On this Day of the Month Each Month

Reason for the Payment

Credit Card Information

Card Holder Name

First Name

Last Name

Credit Card Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Credit Card Number

Credit Card Type

VISA

Mastercard

AMEX

Discover

CVV

Expiration Date

By typing my name here, I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

One-Time Credit Card Authorization Payment

Recurring Credit Card Authorization

Elite Educator, LLC

Institute of Research & Development

Elite Entrepreneur Empowerment Foundation, Incorporated

eliteeducator.com

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