Keane CC Auth Form Cardholder Name * Phone Number * Email* Is your Credit/Debit card BILLING address the same as your SERVICE address? * YesNo Please enter your credit/debit billing address * Please enter your service address Card Type *VisaAmexMaster CardDiscoverOther Card Number* CVV* Expiration date* Would you like the monthly maintenance debit to take place on the 1st or 15th? * 1st of each month15th of each month Acknowledgement of terms*By checking this box I agree to the below terms & conditionsI understand that this authorization will remain in effect until I cancel it in writing or email to info@keanelandscaping.com, and I agree to notify Keane Landscaping Inc. in writing or email of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I acknowledge that the organization of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in the agreed Keane Landscaping Inc. contract.
