Payment Authorization 2019-11-06T09:27:44+00:00

Credit Card Payment Authorization

By signing this form, you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

  • authorize Mianna Marketing to use my Credit card for the purpose of funding our agreed upon advertising campaigns and mediums.
  • Billing Details

  • Credit Card Information

  • This field is for validation purposes and should be left unchanged.