7 Safety Training LLC Credit or Debit card authorization form To process your credit card please complete ALL HIGHLIGHTED areas Card Holder Name* First NameLast Name Phone Number* Please enter a valid phone number. Company Name (only if it’s a company credit card): First NameLast Name Heading I authorize 7 Safety Training LLC charge the above credit card for the authorized amount. I have read and reviewedcancellation and deposit policy and agree to the terms as written. I understand that failure to providethree (3) days advance notification of registration cancellation may result in forfeiture ofdeposit payment (s). Further, no course completion material (s) will be released until ALL accountbalances have been paid in full. Current Date:* -Month -DayYearCard member acknowledges receipt of goods and or services in the amount of the total shown hereon andagrees to perform the obligations set forth by the card member’s agreement with the issuer. Card Holders’ Signature: Amount to pay* prevnext( X )USDDescription Credit Card Details First Name Last Name Credit Card Number Security Code Card Expiration 7 SAFETY TRAINING LLC Office 929-461-5203 • Email.: 7safetyny@gmail.com • www.7safetyny.com 67-21 Roosevelt Ave. Woodside, NY 11377 Submit Should be Empty:
