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

I,
authorize

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.