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Credit Card Authorization Form
By completing this form, I authorize Innovative Dairy Solutions (IDS) to charge my card indicated below for services and products purchased from IDS. A receipt for each payment will be provided to me. I agree that no prior-notification must be provided.
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Name
*
First
Last
Farm Name
Billing Street
*
City
*
State
*
Zip
*
Email
*
Phone Number
*
Card Type
*
Visa
MasterCard
Discover
Cardholder Name
*
First
Last
Account/CC Number
*
Expiration date (--/--)
*
Billing Zip Code
*
I understand that this authorization will remain in effect until I cancel it in writing. 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 this authorization form.
*
I agree
Date
*
**If you would like us to give you a call if your invoice is over a certain amount before auto-charging your credit card on file, please note the amount here:
Submit