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. SWG will continue to provide detailed statements. I certify that I am authorized to sign this form on behalf of the Customer’s Name. This information will be maintained securely by SWG. I will notify SWG in the event that the credit card information below is lost, stolen, expires or is canceled. SWG does not apply a convenience fee to payments made with a credit card on file.

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