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Credit Card Form - Recurring Invoicing
Email *
Todays Date
MM
/
DD
/
YYYY
Business Name
Persons Name
Contract #
Dollar Amount Each Billing Cycle *
Name on Credit Card
Card Type
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Credit Card Mailing Address (Street, City, Zip)
Card Number
Card Expiration
I Authorize Vital Outdoor Advertising to run my Credit Card for the above contract each billing cycle/invoice.
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Card CVC Code (3 Digits)
Initails (first, middle, last)
Submit
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