Signer Account Details
I hereby authorize Local Motion, LLC, hereinafter called, to initiate debit and or Credit entries to the Credit Card account indicated in this form. I acknowledge and authorize, that if indicated, the Credit Card and account in this form will be used in recurring payments.
Note: All written debit authorizations must provide that the debtor may revoke the authorization only by notifying the originator in the manner specified in the Authorization.
CANCELLATION NOTICE: This authorization is to remain in full force and effect until the NAMED above has given written notification of its termination.