Credit Card Authorization Form • Mundesigns

By filling out this form you give authorization and consent to Mundesigns to charge your credit card per the agreement you are executing with our agency. To cancel this authorization you must make a request by email with the subject "CREDIT CARD AUTHORIZATION CANCELLATION" to info@mundesigns.com. Authorization cancellations go into effect 8 days after the request. Chargebacks will be disputed with your credit card issuer and, by submitting this form, you agree to be liable to a fee of 15% of the total chargeback amount.
Name on Card*
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Type of Credit Card (Visa, MC or AMEX)*
Credit Card Number*
Exp. Date*
3 or 4 Digit SCV (Security Code)*
Email to send invoice to:*
Signature*