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HostedinCanada.com / UpFrontbyDesign.com
700, 1816 Crowchild Trail NW
Calgary, Alberta T2M 3Y7
email:deanw@hostedincanada.com

Toll Free: 1-866-730-2040
Main Phone: 403.730.2040

CREDIT CARD AUTHORIZATION FORM

Description of Services:

Web Design and Development, Online Marketing and Technical Services.

Payment terms and conditions: The Client agrees to pay the amount of $10.00 for the provision of the Services. The client acknowledges that a non-refundable 50% deposit is required upon execution of this agreement with 35% due upon completion of designs/wireframes and 15% is due and payable either upon completion and prior to releasing the web design. I, authorize 1529966 AB Inc., O/A Up Front By Design or HostedinCanada to charge my credit card indicated below to discharge the above debt for Services.

Personal Information:

Name:

Billing Address:

City and Province:

Postal Code:

Phone Number:

Email:

Credit Card Information:

Visa

Mastercard

Cheque

Bank Draft

Cardholder Name:

Card Number:

Expiration (MM/YR):

I authorize Up Front By Design to charge the credit card indicated in this authorization form according to the terms outlined above. I understand that this authorization will remain in effect until the debt is fully discharged, and I agree to notify the business in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. I certify that I am an authorized user of this credit card and that I will not dispute the payments with my credit card company; so long as the transactions correspond to the terms indicated in this form.

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Signed by Dean Wolf
Signed On: June 13, 2022

Timestamp

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June 9, 2022 1:51 pm MDT

Credit Card Authorization Uploaded by Dean Wolf - deanw@hostedincanada.com IP 96.51.8.39