Credit Card Authorization Form

  • Card Type

    Please Check One

  • Billing Information

  • Credit Card Information

  • Client Info

  • MM slash DD slash YYYY

  • In the event you wish to change the credit card authorized herein to be charged, Iris Healing Retreat requires notice of the desired change in writing, dated, and including the language set forth herein and all necessary card information, as well as the date on which the desired change shall be effective, and the cardholder’s signature. Cardholder agrees to update Iris Healing Retreat with a new authorization prior to the expiration date of the card authorized herein to be charged, in order to ensure payments may be charged prior to services being rendered. I have the right to change or terminate this authorization at any time but must do so in writing via email to [email protected] The termination of this authorization shall be effective 24 hours after we receive the termination notice.

    I, the undersigned, understand that all financial payments are considered final sale and are non-refundable.
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  • MM slash DD slash YYYY