CREDIT CARD / ACH PAYMENT AUTHORIZATION

Recurring Charge - You hereby authorize regularly scheduled charges and the one-time setup fee to your credit card or bank account as agreed upon within your executed service agreement. You will be charged for each completed mystery shop service evaluation at the agreed upon fee plus reimbursement of required purchase expenses (if any) on or around the fifth (5^th) day of the month following the completion of the evaluations unless other payment arrangements have been made. An itemized receipt for each payment will be provided to you and the charge will appear on your credit card or bank statement as BBM America, LLC or CX Orlando. You agree that no additional prior-notification will be needed.

Billing Address:

Billing Information:

Select Payment TypeBank Account (Checking)Bank Account (Savings)Visa Credit CardAmerican Express Credit CardMasterCard Credit CardDiscover Credit Card

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the BBM America/CX Orlando in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that the merchant may at its discretion attempt to process the charge again within 30 days, and agree to an additional $50.00 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form.

Signed, Sealed, and Delivered in the Presence of: