If your payment is 5 days past due you will be billed an additional $35 to the card on file. (CREDIT RESTORATION ONLY)

Only select this option if your account IS NOT past due. 

I authorize the above named business to charge the credit card. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the business in writing of any changes in my account information or termination of this authorization at least 30 days prior to the next billing date.  If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. This payment authorization is for the type of bill indicated above. I certify that I am an authorized user of this credit card(s) and that I will not dispute the payments with my credit card company provided the transactions correspond to the terms indicated in this authorization form. You understand that if your account is 10 days past your payment due date you will be billed an additional $35 late fee. If your account is not satisfied within 31 days your account will be turned over to collections and placed with Equifax, TransUnion, and Experian.