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I permit TRINITY SITE SERVICES to charge my credit card regularly and to fix any errors in transactions. This permission remains until I notify THE COMPANY in writing to cancel it, giving enough time for the company and my bank to process it. I will be charged the correct amount every billing period. I will receive an email receipt for each payment, and the charge will show on my bank statement as “Trinity Site Services.”

Credit Card:

VISA

MasterCard

Discover

AMEX

Cardholder Name *

First Name

Last Name

Billing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Card Number *

Expiration Month *

Expiration Year *

3-diget code *

Maximum Amount (per charge) *

$

Please Sign *

Date

MM

DD

YYYY

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