creditcardauthorization

Credit Card Authorization

Name as it appears on card

Type of credit card

Card number

Expiration date

CVV code back of card Zip Code

AUTHORIZED USER INFORMATION

Name

Phone number

Driver's license number

Type of charge

Authorized amount

Date of charge Select Charge Type

I certify that I am the authorized holder and signer of the credit card referenced above. I certify that all information

above is complete and accurate.

I hereby authorize collection of payment to Action Maid Service for charges as indicated above. Charges may

not exceed the amount shown in the AUTHORIZED AMOUNT field.

I understand that any and all complaints about the service preformed must be made within 3 DAYS from above date.

All complaints must be put in written form via EMAIL to Michele@actionmaidservice.com or TEXT to 410-608-0591

Electronic signature authorizing Action Maid Service to charge credit card

Signature

Initial

All Fields

Are

Required

After you submit your information you will be redirected to our cancellation page. Please read our cancellation policy.