Recurring Payment Authorization Form-- ACH or Credit Card ...
Amex Discover. Cardholder Name _____ Account Number _____ Exp. Date _____ CVV (3 digit number on back of card) _____ SIGNATURE DATE . I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Texas Childcare Systems in writing of any changes in my account information or termination of this ... ................
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