Credit Card Authorization | KLBE

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Credit Card Authorization
Card Type*
Card Number*
Card Holders Name*
Amount*
Expiry Date*
Card Security Code*
Invoice Number*

Please Click the + button to add additional invoices
Options*
- Pay Listed Invoice
- Keep On File For Month End Payments
- Email Payment Confirmation
- Keep On File For Payment of Each Invoice
- Keep On FIle For Telephone Authorization
Signer's First Name*
Signer's Last Name*
Signer's Phone*
Signer's Email*
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Name
This field is for validation purposes and should be left unchanged.