[YOUR ADDRESS] [YOUR PHONE] [YOUR EMAIL]

[YOUR BUSINESS NAME]

[CLIENT ADDRESS] [DATE]

Dear [CLIENT NAME],

Please complete the following recurring credit card billing authorisation and return by;

Fax: [YOUR FAX]

Post: [YOUR ADDRESS]

Regards,[YOUR NAME]

-----------------------------------------------------------------------------------------------------

Please debit the selected credit card MasterCard Visa

For the Amount of ___________________________________________________________

Every __________________________________________________________________

Card Number

Expires __ __ / __ __ CCV ________

Cardholders Name ___________________________________________________________

Signature ____________________________________________ Date__ __ / __ __ / __ __