Credit Card Authorization Form

This form authorizes Blu Skye Media, Inc. to charge your credit card after each job is complete. Your card will NOT be charged immediately after filling out this form. Charges will appear as “Blu Skye Media” on your statement. Thank you.

Name

As it appears on your card

First Name

Last Name

Checkbox

Visa

MasterCard

American Express

Credit Card Number

Expiration Date

Security Code

Date

Please Enter Today's Date

YYYY

Phone

(###)

###

####

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Signature

Please Select One

Keep my credit card on file for future payments.

Do not keep my card on file.

Invoice Reference

Optional