Credit Card Authorization

Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.

Client Name

Cardholder Name (as shown on card)

Cardholder Address

Card Type

Visa

MasterCard

Card Number

Expiration Date (mm/yy)

CVV # (3- or 4-digit number on the back of the card)

I agree that a no-show fee of $50 will be charged for cancellation of my appointment without notice

I agree that should an invoice owing for services rendered to the client named above become overdue, the full balance of the invoice(s) will be charged to my credit card

Charge all invoices for the client named above to this card (OPTIONAL - if this box is not selected an invoice will be emailed to the customer on file for payment via credit card or e-transfer)