One Time Credit Card Payment Authorization Form
Sign and complete this form to authorize Moshe Klein & Associates, Ltd. to make a one time debit to your credit card listed below.
By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. I certify that I am an authorized user of this credit card. I understand that my credit card will be charged when the tax returns are completed. I understand that the exact fee will not be known to me until the tax returns are completed along with required forms and schedules. I have reviewed the fee schedule for tax returns provided to me and understand that the fee for services to prepare my tax returns will depend on the complexity of my returns. I understand that there will be a $25 charge for credit cards that are declined for any reason and a late fee of $25 will be added to the amount due plus 2% interest monthly on the unpaid balance till it’s paid in full.
By my signature, I acknowledge that I have read, understand, and agree to the policies, terms, conditions and procedures as outlined on this document.
By signing this Acknowledgement, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding