Credit Card Recurring Payment Authorization Form--Variable ...



Carol A. Reithmiller, CPA, PLLC11020 South Tryon Street, Suite 406Charlotte, NC 28273Phone: 704-583-9090Fax: 704-583-9843C-Corporation Tax Extension and CPA Fee Payment Authorization FormCheck the Services RequestedNorth Carolina Annual Report: Due March 15, 2019 (to us by March 12, 2019)_____ North Carolina Annual Report - $110 C-Corporation Tax Return Extensions –Extends Due Date October 15, 2019 Information to us by September 18, 2019**Note – This is for additional time to file the return, not additional time to pay.All tax payments are due April 15, 2019**_____ Federal Extension - Form 7004 - $85_____ State Extensions are $85 each: which states ___________________________________ $150 Rush Fee for all requests made on September 19th – 25th, 2019_____$200 Rush Fee for all request made on September 26th – Oct 3rd, 2018_____$250 Rush Fee for all requests made on October 7th and 8th, 2019. After October 8th, Call for pricing for extension processing (may not be available).Please complete the information below:I FORMTEXT ____________________________ authorize Carol A. Reithmiller, CPA, PLLC to charge my credit (full name)card indicated below for the requested tax extension (s). Total amount of $___________ Company Name FORMTEXT ____________________________ (fill out one form per company)Billing Address FORMTEXT ____________________________Phone# FORMTEXT ________________________City, State, Zip FORMTEXT ____________________________ Email FORMTEXT ________________________ Card Type: FORMCHECKBOX Visa FORMCHECKBOX MasterCard FORMCHECKBOX Amex Cardholder Name FORMTEXT _________________________________________________Account Number FORMTEXT _____________________________________________Expiration Date FORMTEXT ____________ CVV (3 or 4 digit number on back of card) FORMTEXT ______ SIGNATURE DATE I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. This payment authorization is for the type of bill indicated above. I certify that I am an authorized user of this credit card and that I will not dispute the scheduled payments with my credit card company provided the transactions correspond to the terms indicated in this authorization form. Extensions will not be processed without valid payment. ................
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