Payment Authorization Form

Existing Order number if applicable

First & Last name on order*

Email address associated with order*

Full Billing address*

Card Type*

Credit/Debit Card Number*

Expiration Date*

3 Digit Security code on the back*

Frequency*

How much would you like to pay?*

Card Authorization Agreement: I understand & authorize Elea’s Closet LLC to charge my card per the setup arrangement that I have listed above. I understand that this will stay in effect until the balance of my order is paid in full, until I make changes to this agreement or until I cancel it. I understand to cancel it, I must reach out to Elea’s Closet LLC via email at Elea@eleascloset.com and notify them within 7 days prior to the charge 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 acknowledge that the origination of Credit Card 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 and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this authorization form.*

Type your First & Last Name as your signature acknowledging and authorizing this payment arrangement*

Additional Notes/Instructions regarding your payment arrangement or order?