Credit and debit card payment authorization

By submitting this form online, you will be charged for the amount indicated below. A receipt for each payment will be provided to you upon authorization from your bank and the charge will appear on your Card Statement.

The individual named below authorizes Executive Offices to charge their credit or debit card for the amount indicated on this form, on the noted date:

Amount:

Enter Amount to be Charged in US Dollars. This amount does not include processing fee (see terms below).

Date:

MM

DD

YYYY

Frequency:

Check the following box if you wish to opt-out of recurring charges.

One (1) Time Charge Only

Services:

Suite Number:

If Aassigned

Billing Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone:

Country

(###)

###

####

Email:

You will receive notification from Executive Offices when payment has been processed.

Card Type:

Select One Option

Card Number:

Enter Full Credit or Debit Card Number

Expiration Date:

MM / YYYY

Security Code (CVV):

Digits on your card.

Final Authorization

By checking this box, you agree that the information above is correct to the best of your knowledge, that you have all of the Terms on this page, and that you attest you are the authorized representative to approve charges to this credit or debit account.

I Authorize Executive Offices to Make the Charge

By electronically signing and submitting this form online, you agree to the following terms:

You will be charged for the amount indicated in the form above.
Services Rendered are for: Executive Offices Rent and/or Deposit Payment.
A 3% Processing Fee will be charged to United States cards, and 5% will be charged to International cards.
A receipt for each payment will be provided to you upon authorization from your bank and the charge will appear on your Card Statement.
You authorize Executive Offices to charge your card monthly as per the invoiced rent (provided separately to client) unless you selected to opt out by checking the box above. You agree that no prior notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.
You grant Executive Offices with permission to debit your account for the amount indicated on or after the indicated date.
You also attest that you understand and agree to the terms listed on this form, and that you have access to this same information in printed format upon requesting it from Executive Offices.

Submit Secure Payment Information

Credit and debit card payment authorization