Alan Behrman & Associates, PC

    2876 Johnson Ferry Rd., Suite 150 Marietta, GA 30062
    770-361-7864 [email protected]

    Credit Card Authorization Form

    *This form is completely confidential*

    Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.

    Credit Card Information

    ** Card Type: Mastercard, VISA, Discover, Amex, Other


    to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.