Computer Services

Tel 650.548.1010
Burlingame, CA USA

MikesHardware.com - Automatic Credit Card Billing Authorization Form

Please print this form and fax it to MikesHardware.com at (801) 315-9328.
DO NOT MAIL OR EMAIL THIS FORM

If you would like the convenience of automatic billing and take advantage of the low MRMA client rate of $55 per hour, simply complete the Credit Card Information form below and sign the form. All requested information is required. We will bill your credit card for the amount indicated and your total charges will appear on your monthly credit card statement. You may cancel this automatic billing authorization at any time by contacting us at (650) 548-1010.

Customer Information ( To be completed by MikesHardware.com ) 

Customer Name Customer account number  Phone 
     
Address:

MRMA Service Fee Payment Information
This is for your monthly MRMA service fee. This amount is automatically charged to your credit card on the 1st of every month.

I authorize MikesHardware.com to automatically bill the card listed below as specified:
Amount $  Monthly
Start billing: Month ________________ Day __________ Year ___________

Invoice/Work Order Payment Information
Work orders and invoices are billed to your credit card 11 days from the date of service.

I authorize MikesHardware.com to automatically bill the card listed below as specified:
Customer's signature

Credit Card Information ( To be completed by client ) 

Credit card type: Credit card number Expires
     

Cardholders name (as shown on card) Cardholders Zip Code (required)
   

Customer's signature Date
   

MikesHardware.com | 1675 Rollins Road, Suite B2 | Burlingame | California | 94010 | 650.548.1010