credit card change



Credit Card Change Addendum

I hereby authorize SeniorLeads to update the credit card on file for the billing of services rendered according to the terms of the service agreement, to the following:

Card Holder Name:  
Credit Card number:    
Expiration:   
3-digit Security Code on back of card:   
Billing Street Address:   
City:   
State:   
Zip:   

I acknowledge that the terms and conditions put forth in the initial Service Agreement remain the same and will apply to the updated credit card information, provided above.

Select one of the checkboxes below:

WE WILL USE THIS NEW CARD FOR ANY OUTSTANDING BALANCE AND FOR CHARGES GOING FORWARD. IF YOUR ACCOUNT HAD BEEN SUSPENDED, WE WILL REACTIVATE YOUR ACCOUNT UNLESS YOU CHECK BELOW TO CLOSE YOUR ACCOUNT

ALLOW ONE FULL BUSINESS DAY FOR THE AHNCGE TO BECOME EFFECTIVE

Leave this empty:

Signature Certificate
Document name: credit card change
Unique Document ID: 475a6597b8b79221eb8d374f79026deeea433c78
Timestamp Audit
July 11, 2018 2:08 pm PSTcredit card change Uploaded by Jennifer Blair - [email protected] IP 24.5.135.88, 24.5.135.88
July 11, 2018 3:20 pm PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 24.5.135.88, 24.5.135.88
July 11, 2018 3:24 pm PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 24.5.135.88, 24.5.135.88
July 12, 2018 10:33 am PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 24.5.135.88, 24.5.135.88
July 12, 2018 10:35 am PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 24.5.135.88, 24.5.135.88
July 12, 2018 10:43 am PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 24.5.135.88, 24.5.135.88
July 12, 2018 12:42 pm PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 24.5.135.88, 24.5.135.88
July 12, 2018 12:44 pm PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 24.5.135.88, 24.5.135.88