I agree to electronically sign this form. Under penalties of perjury, I declare that by checking this box, I have examined this document and, to the best of my knowledge and belief, it is true, correct, and complete. I, __as named above___as an authorized user of the above credit card, do hereby agree that Mobile Sleep Components LLC (“MSC”) may automatically charge the above listed credit card for all sales transactions including sales orders and invoices that are billed to Company Name referenced above. I agree to pay such charges in accordance with my card issuer agreement or other governing document and will not dispute these scheduled transactions with my bank or credit card provider, so long as the transactions correspond to the terms indicated in this authorization form. I am also aware that I will receive an order notification for my records. I understand that this authorization will remain in effect until I cancel it in writing which will take effect upon receipt by MSC, and I agree to notify MSC in writing of any changes in my account information or termination of this authorization. My signature, whether electronic or original, is bound to this agreement. Send
