Authorization for Credit Card Debit
To: __________________________(Credit Card Company)
From_______________________________ (card Holders Name)
I authorize my payment through PayPal for $ _______________ to pay my dues to
Troup County Board of REALTORS®. I also understand that this payment is
Non refundable and cannot be disputed through the above named credit card
Company since I have given permission and authorization for the above funds to be debited from my credit card.
Signed ________________________________Dated ________________________________
FORM MUST BE SIGNED, DATED AND FAXED TO 706-884-2601
OR MAILED TO 115 BROAD STREET, SUITE 203, LAGRANGE, GA 30240
WITH IN ONE WEEK ON PAYMENT!!