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First or One Time Fee:
Recurring Thereafter:
*Card Brand:
*Card Number:
*Expiration Month:
*Expiration Year:
*CSC, CVC, CVV/2 #:
*First Name:
*Last Name:
*Address:
*City:
State:
*Zip Code:
*Email Address
*Phone:
I authorize ProTidy Services Incorporated to initiate credit or debit entries to my credit card account listed above after (never before) each service for the amount indicated. This authority is to remain active until ProTidy Services Incorporated has received notification from me. The credits and debits pursuant to this agreement will be processed through First American Payment Systems
*Type "YES" To Accept:
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