Recurring Payment Authorization Form ach or Credit Card Payment

Tenstreet, LLC
5121 S. Wheeling Ave., Ste. 200
Tulsa, OK 74105
Direct Line: 918-949-6823
Fax: [phone]
[e-mail]
Recurring Payment Authorization Form
Schedule your payment to be automatically charged to your Visa or MasterCard. Just complete and sign this form to get started!
Here’s How Recurring Payments Work:
You authorize regularly scheduled charges to your credit card. A confirmation for each payment will be emailed to you and the charge will appear on your statement.
Please complete the information below:

I David Franklin  authorize Tenstreet, LLC to charge my credit card

(full name)

indicated below for the amount indicated on my monthly invoice from Tenstreet, LLC on or around the 20^th of each month for payment of said invoice with Tenstreet, LLC. I also understand that a processing fee of 3% will be added to my monthly balance due and charged at the same time.

Billing Address 3424 N Marshall RD APT 111 Phone#747 262 5101
City, State, Zip Kettering, OH 45429 Email [e-mail]
Credit Card
Visa MasterCard
Cardholder Name Rasuljon Narimonov
Account Number 4278 3100 2078 4765
Exp. Date 09/25
CVV (3 digit number on back of card) 726

SIGNATURE David F. DATE 11.15.2022

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Tenstreet, LLC 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. I certify that I am an authorized user of this credit card and will not dispute these scheduled transactions with my credit card company; so long as the transactions correspond to the terms indicated in this authorization form.