[YOUR BUSINESS NAME]

[CLIENT ADDRESS]
[DATE]

Dear [CLIENT NAME],

Please complete the following recurring credit card billing authorisation and return by;
[YOUR ADDRESS]

Fax: [YOUR FAX]

[YOUR PHONE]
[YOUR EMAIL]

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__ __ / __ __ / __ __