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Credit Card Authorization Form


Two ways to complete the form:
1.) You may submit the online credit card form below
OR
2.) You can download, print, and complete the
credit card authorization form and email to:

​ vcxpress@comcast.net
(link to download is at the bottom of the page)

​or
Fax it to us at: 800-538-9197


Note:We will need a copy of your Driver's license along with the below form


    Credit Card Authorization Form

    Mos./Year 00/0000
    3 digits on back of card
Submit

Please note:
​
There will be a failed payment fee
(an additional charge of 30%)
for ​declined credit cards

vcx_credit_card_authorization_form_.pdf
File Size: 170 kb
File Type: pdf
Download File


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