Credit Card Authorization Form

Compliant Background Screening Partners, LLC. will accept Mastercard, Visa, American Express and Discover card payments.

Completely fill out the form to ensure timely processing.  All provided information is strictly confidential.

Cardholder Name:

Company:

Payment For (Customer Name)

Billing Address:

City State             Zip

Phone:              (Format: 999-999-9999)

Email:

Credit Card Number:

Expiration Date:(Format: 02/09)

Card Security Code:    3 digit code on back of card

Signature:

        Cardmember agrees to pay in accordance with agreement

           Govering use of such card.          

                        

Certification: By choosing to submit this form electronically, I certify and agree that by entering/typing my name and information in the above spaces, I bind and legally obligate myself to the same extent as I would by signing my name on a printed version of this form.  I also certify that I have read, understand and accept the Agreements, Policies and Procedures set forth by CBSP, LLC.  I also give permission to CBSP, LLC. to use my credit card for payment of services rendered.

Please note:  Chargebacks and declined transactions may be subject to an additional handling fee.  Questions regarding credit card payments can be sent to cbsp@comcast.net

We reserve the right to limit access to our services based upon verification of your business.

   

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