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Secure Payment Authorization

Complete this form to securely vault your payment method for your monthly marketing services.

Bank-Level Security via Stripe

PCI-DSS Compliant: Your payment details are securely vaulted directly by Stripe.
Zero Data Storage: EC Marketing For ALL does not store or process raw credit card data on our servers.
Locked-In Pricing: Secures your discounted agency rates and entirely prevents late payment penalties.

1. Business & Contact Information

Legal Business Name

Authorized Signer Name

Billing Email Address

Direct Phone Number

2. Secure Payment Details

Credit or Debit Card

3. Billing Address

Street Address

City

State

Zip Code

4. Authorization Agreement

I hereby authorize EC Marketing For ALL to securely vault my credit card via Stripe and to charge my account on the pre-arranged monthly date for the agreed-upon digital marketing and/or hosting services. I understand that this authorization will remain in effect until I cancel it in writing. I certify that I am an authorized user of this credit card.

I agree to the terms above.

Electronic Signature (Type Full Name)

Date

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