THE SILVER LAW FIRM

1650 S. Dixie Hwy., Suite 300, Boca Raton, FL 33432

www.CreditRepairLegalSvc.com
Office: (561) 750-2217
Fax: (561) 750-2019
Credit Card Authorization

1 , ________________________________________________, hereby authorize THE SILVER LAW FIRM

to charge an amount of $ 99.00 per month* to the credit card listed below for purposes of representing me with
credit repair.
I understand that the charged amount is non-refundable.

Credit Card # _______________________________________

Type of Card:_______________________________________
Expiration Date ____________________
Name on Credit Card__________________________________________
Billing Address________________________________________________________________
Security # from Back of Card ___________
Signature_____________________________________________
Date________________________
* I understand that the above referenced card will be charged initially following the complete performance of the of
the services listed in Stage 1, and then monthly from the day of the first charge to cover the next portion of my
payment and each subsequent month until THE SILVER LAW FIRM's fees are paid in full for the services rendered.