Client Payment Authorization Form

I hereby agree to the following: *

I, being the authorized account holder or the Corporate Officer, by signing above I understand and agree to the terms set forth in this agreement, agree to pay, and specifically authorize to charge my account for the services provided. I further agree that in the event my account information becomes invalid, I will provide new valid information upon request, to be charged for the payment of any outstanding balances owed.
I understand that payment(s) made for services delivered by this firm is non-refundable.
I hereby authorize Kevin Puckett Attorney at Law, LLC to charge my debit and/or credit card the balance currently due in the following amount:

Dollar Amount I Hereby Authorize Kevin Puckett Attorney at Law, LLC to Charge My Debit and/or Credit Card: *