Card Authorization Form

We have implemented a policy that enables you to maintain your credit card information securely on file with The Clay Media. In providing us with your credit card information, you are giving The Clay Media the permission to automatically charge your credit card on file according to the terms outlined in the contract.

Please complete all fields. You may remove your info at any time by contacting us. This authorization remains in effect for the duration of our support and can be ended at any time based on your discretion. Thank you!

Please enable JavaScript in your browser to complete this form.Card Type*

• MasterCard
• VISA
• Discover
• AMEX
• Other

Card NameCardholder Name (as shown on card) *Card Number # *Expiration Date (mm/yy) *Card Security Number (CVV) *Billing Address *Zip CodeEmail Address for Receipt *I authorize The Clay Media to charge my credit card above. I understand that my information will be saved to file for future transactions on my account. *

• I authorize The Clay Media to charge my credit card above. I understand that my information will be saved to file for future transactions on my account.

Customer SignatureClear SignatureDateSubmit

All information is kept confidential and used only for the purposes as noted above.