Secured Online Credit Card Authorization Form


This form serves as authorization for deposits/ payment according to terms agreed upon in service contract and as a guarantee of payment.

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Phone: (404) 983-0820
Email: info@ixstech.com

I authorize the use of my credit card according to the terms of the service contract &/ or understand that if deposits and payments are not made by the agreed upon due date, IXS TECH LLC is authorized to charge my credit card. I understand these charges will take place 5 business days after payment is due if payment has not been received.
I agree that the information below  the same on the credit card and registered user.

Your Name

Card Number

Exp

CCV


Billing Address

City

State

Zip Code

Phone Number

Email

Invoice Number