Credit Card Payment Authorization and Confirmation Form.

Please complete the form below or print a copy and fax it to us.
*Required Fields


Credit Card Type* (please select one)

(1 Evictions does not require expiration and security code for this authorization.)

I have made a payment to the above named business by credit card indicated in this authorization form according to the terms outlined above. This payment authorization was for the goods/services as provided . It is stipulated that this authorization is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company so long as I receive the services of Legal Helper/1Evictions.com. I am the card holder of who's name is listed above.

Please sign or indicate by checking the box below that you have authorized 1Evictions to charge the amount indicated above, to the credit card indicated.

security code
Enter Security Code: