Credit Card Authorization | Appointment On Demand

NOTE: You can make changes to your account by resubmitting this same form with updated information at anytime!

Cardholder Information

Name:*

Company Name*

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Minimum Appointment Agreement

How many residential appointments are you willing accept and pay for in a calendar week

You are responsible to purchase each appointment( $39-$80 per appointment depending on your trade). We strongly recommend listing an appointment amount your firm can budget both in cost and time flexibility. This can be changed at anytime.

How many commercial appointments are you willing to accept and pay for in a calendar week

You are responsible to purchase each appointment( $39-$80 per appointment depending on your trade). We strongly recommend listing an appointment amount your firm can budget both in cost and time flexibility. This can be changed at anytime.

Consent*

I authorize charges for appointments between $39-80

*

I consent the types of appointments I will be purchasing are consistent with the information I have provided on the contractor questionaire form.*

*

I understand i am responsible to purchase the amount of appointments in a weeks time I have listed under this minimum appointment agreement.*

*

I understand and agree to my card being charged once I am issued an appointment*

*

I understand that Appointment On Demand will attempt to coordinate with my firm in an effort to schedule a time and date of appointment that works well for both my firm and the client looking to book an appointment. However it is ultimately my responsibility to find availability to accomodate the clients scheduling needs . Because of this, i understand and agree to purchase all appointments consistent with my minimum appointment agreement and my contractor questionnaire. *

*

I understand in order to turn my service off temporarily in order to avoid purchasing appointments when my firm is unavailable, I must send an email to service@appointmentondemand.com requesting such. I understand my request will be granted within 24 hours. *

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I agree to charge my card $50 for required security deposit*

What's this?

Credit Card Information

Credit Card Type*

Visa
Mastercard
American Express
Discover Card

CC Number*

Please enter your 16 digit card number (Enter with numbers only, no dashes)

CVV Code*

Expiration Date*

Month	Year

MM and YYYY format for Month and Year respectively.

Card Holder Signature*

By signing this I am agreeing to purchase the amount and type of appointments as described above using the credit/debit card listed above (this can be canceled or changed at any time)

Date*

Hidden Fields:

Email

Form 3 of 4: Credit Card Authorization Form

Cardholder Information

Minimum Appointment Agreement

Credit Card Information

Hidden Fields: