Please sign below:
By signing above, I confirm that I am an authorized user of the card being used for this transaction and understand and agree to the terms and conditions of this payment. I also agree to pay, and specifically authorize to charge my credit card for the services provided. I further agree that in the event my credit card becomes invalid, I will provide a new valid credit card upon request, to be charged for the payment of any outstanding balances owed.
This form authorizes Tarlow Stonecipher Weamer & Kelly,
PLLC to make charges to your credit card for legal services performed on your
behalf or for an initial consultation. This transaction will occur
utilizing our secure merchant credit service account. A processing
fee, not to exceed 3% of the total amount, will be added to each transaction.
After this transaction is processed a confirmation receipt will be emailed to
the email address provided.