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Credit Card Payment
"
*
" indicates required fields
Date
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Card Holder Name
*
Company Name
Credit Card Billing/Shipping Address
*
Card Number
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Expiration Date
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CVV#
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Amount
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Invoice (Optional)
Select Type
Visa
Master Card
Email
Consent
I authorize East Harbor Financial to withdraw payments via Credit Card
The undersigned hereby authorizes East Harbor Financial to initiate payments to the undersigned’s credit card indicated above for payment of sums due in connection with their contract(s). The undersigned further authorizes the depository named above to charge the indicated credit card for any future payments. Credit card payments are subject to a 4% convenience fee. The authorization is to remain in full force and effect until East Harbor Financial shall have received written notification of its termination in such time and in such manner as to afford East Harbor Financial and depository a reasonable opportunity to act on it.
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