This will be good until I cancel by mail or email. Or until the account is canceled by either party. I will notify Elite.Net of new card numbers or expire dates if there are changes on a new copy of this form.
Accepted cards are: Visa, MasterCard, American Express, Discover and cards with the NOVUS logo.
Card Type (visa/mastercard/etc):______________________________
Name on card:______________________________
Effective date of authorization:______________________________
Number:______________________________
Expire Date:______________________________
Signed by card holder:______________________________
Name:______________________________
Address:______________________________
City, State ZIP:______________________________
Elite.net User name(s):______________________________
Phone:______________________________
Special Instructions:______________________________