Green Turf Lawns
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LAWN OVERSEEDING SPECIAL
Credit Card Authorization Form
By filling out and submitting this form you authorize Green Turf Lawns to charge
your credit card the first of each month for the specified amount and duration period:
CARDHOLDER TO FILL OUT THIS SECTION
*
Indicates required field
Recurring Amount
*
$41.53
Payment Start Date
*
April
Day
*
28
Year
*
2018
Payment End Date
*
December
Day
*
28
Year
*
2018
Cardholder name as it appears on credit card
*
NAME MUST MATCH WHAT IS ON CREDIT CARD
Cardholder's address as it is with the credit card
*
City
*
State
*
Zip Code
*
DO NOT FILL OUT THIS SECTION. WE WILL CALL TO GET THIS INFO.
Cardholder email address
*
Phone Number
*
Credit Card Information
Credit card number
*
FOR SECURITY PROPOSES, WE WILL CALL TO GET YOUR EXPERATION DATE AND 3 DIGIT SECURITY CODE.
CARDHOLDER TO SIGN AND DATE THIS SECTION
/S/
Cardholder electronic signature
*
Date
*
Submit