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Credit Card Authorization

Thank you for choosing Minds Over Marketing. The following form authorizes us to process your invoices according to the terms of your project or agreement.

This form will NOT be sent over the internet.

Please complete the required information, print the form, sign it and
fax it to us at 818-332-5087. You will receive a confirmation by email.

Company/Organization:
Credit Card:
 Visa    MasterCard   American Express   Discover
Cardholder Name:
Credit Card Number:
Security Code:
Expiration Date:
Telephone:
Fax:
E-Mail:
Billing Address City:
State:
   Zip:


Cardholder Signature:



PLEASE PRINT AND SIGN THIS FORM
FAX TO Minds Over Marketing at 818-332-5087