Credit Card Authorization Form

    CREDIT CARD AUTHORIZATION FORM

    Revised November 2017

    * Indicates a required field

    This is to authorize Center for Developing Kids as of:

    to make automatic credit charges against my credit card account for services rendered. Monthly invoices with service and insurance funding details (when applicable) will be available promptly after payments are confirmed.



    A receipt will be sent to the email address listed above.




    Please sign below.