Billing Authorization Form

Under your chosen plan, as stated in your Service Agreement, you have authorized Credit Lynx to process your one time setup fee on the selected start date and to process your monthly fee on or about the same day of each month.

Setup Fee and Start Date                                                  Monthly Fee and Due Date

Setup Fee $_________   Start Date ________________                                          Monthly Fee $_________   Due Date ________________

Payment Information

Cardholder Name ______________________________________

Card Number ___________________________________________   Expiration Date ____________   Security Code ________

If Billing Address is different:

Address ___________________________________________________   City _____________________________   State _______   Zip ______________

You understand and agree that for shorter months, charges due on the thirty-first will be taken out on the thirtieth, and in February you will be charged on the twenty-eighth (or twenty-ninth on leap year) should you be setup to pay during the twenty-ninth to the thirty-first time period for work previously and fully rendered. (The specific day of the month may vary slightly due to weekends and holidays.)

You understand and agree that your setup fee covers the creation of your online dashboard and entry of all your credit accounts.

You understand and agree that your monthly fee is not a prepaid payment of Services; all accounts are billed in arrears (after Services have been performed) similar to how a cell phone bill is charged. The unlimited data plan is charging for the data and services you already used from the previous month.

You understand and agree that a final fee will be charged on the day you end Services; depending on which payment method you have selected, fees will either be charged to your credit or debit card or drafted from your bank account.

By providing your electronic signature, you acknowledge that you have received and reviewed this Billing Authorization Form and agree to all its terms and conditions.

Name _____________________________________  Signature _____________________________________________  Date ______________________