© 2016 Action Maid Service. All rights reserved.
Credit Card Authorization
Name as it appears on card


Type of credit card


Card number


Expiration date


CVV code back of card​



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
Initial
Initial
All Fields 
Are
Required



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