Filley & Associates Credit Card Payment by Fax
If you prefer not to make an online credit card payment through Paypal, you can fax us your credit card authorization. Please fill out, print and fax this document to 415-462-9722.
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Your Name |
________________________________________________________ |
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Billing Zip Code for this Credit Card
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________________________________________________________ |
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M/C | Visa | Am Ex | Discover
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________________________________________________________ |
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Card Number
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________________________________________________________ |
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Expiration Date
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________________________________________________________ |
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Security Code (on back of card)
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________________________________________________________ |
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Case # / Name |
________________________________________________________ |
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Authorization Amount
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________________________________________________________ |
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Signature
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________________________________________________________ |
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I authorize Filley and Associates to charge my credit card for the amount indicated above: |