Credit Card Authorization 2

Client Credit Card Authorization Form

Name on Card

Billing Address

Billing Zip

Phone

Card Number

Expiration Date

Security Code

If I cancel my scheduled service on the same day, I will be charged a fee of $150. If I cancel within 48 hours but not on the same day as the scheduled service, I will be charged a fee of $100

As an authorized cardholder or corporate officer, by submitting this form, I understand and agree to the terms set forth in this agreement, agree to pay, and specifically authorize to charge my credit card for the services provided. I further agree that in the event my credit card becomes invalid, I will provide a new valid credit card upon request, to be charged for the payment of any outstanding balances owed.

I am aware that charges made for actual services performed by Cleaning Dino are non-refundable. In the event of pre-payment, any unused funds will be refunded within 30 days. Further, I understand that a service charge of $50 will be added to my final bill if my home is not reasonably DECLUTTERED prior to my scheduled-service.

MINIMAL IMPERFECTIONS such as dirt, crumbs, fingerprints,etc...,inadvertanly left behind by our cleaners, or any unreasonable irregularities are not grounds for a discount.

Your Signature

AR (501) 680-3145

UT (435) 669-6898

CLEANING DINO

Client Credit Card Authorization Form