Payment Agreement I (personally and on behalf of the company named below, if applicable) authorize charging of my credit card, for the requested services, including but not limited to: Contact info Your Name Your Company Your Email (required) Your Phone Number Billing Info Please enter your credit card details exactly as shown on your credit card and billing statement. Name on Card Billing Address Billing City Billing State Billing Country Billing Zip Code Card Info Card Type---VisaMasterCardDiscoverAmerican Express Card Number Card Expiration Date (Month/Year) Card CCV Number I authorize ATLANTIC COAST FLOORING to process my Credit Card above to pay for the services ordered. Please save my payment info to speed up and process future payments.