Credit Card Authorization Form

I authorize Southern Web, LLC (“SWG”) to charge the credit card listed below for payment of fees incurred by the Customer listed below. Credit card transactions are subject to a three percent (3%) surcharge to cover SWG’s cost to accept and process credit card transactions. Payments made by ACH or check are not subject to the surcharge.  Click here to pay by ACH. SWG will continue to provide detailed statements.

I certify that I am authorized to sign this form on behalf of the Customer’s Name. I will notify SWG in the event that the credit card information below is lost, stolen, expires or is canceled. 

Fill out my online form.