CREDIT CARD AUTHORIZATION FORM
PLEASE COMPLETE THIS AUTHORIZATION AND FAX TO: (866)265-9161
OR E-mail: tmckenna@judgmentrecoverysocal.com
NAME ON CARD:
Address:
City State Zip
Phone:
Credit Card Type: _____ VISA _____ MASTERCARD ____ DISCOVER
Credit Card Number: - - -
Expiration Date: /
Month Year
Card ID No. (last 3 digits on the back of card): ________
Amount Authorized: $ ________________ (USD)
Authorized Signature:
