Credit Card Payment Authorization Form

Creative Kids Online Payment Authorization Form

Secure online recurring payment authorization form using Stripe.

URL

This field is for validation purposes and should be left unchanged.

Child/Children Name(Required)

Site Location(Required)

Parent/Guardian Name(Required)

First Last

Billing Address(Required)

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

Phone Number(Required)

Email Address(Required)

Payment Schedule(Required)

Weekly payment, Friday at midnight

Bi-weekly payment, Friday at midnight every two weeks

Payment Amount(Required)

Enter the approved recurring payment amount.

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Payment is processed securely through Stripe. Card details are not stored on this website.

Authorization Agreement

I hereby authorize Creative Kids Inc. to initiate debit/credit entries from my account. I acknowledge that the indicated transaction charges must comply with the provisions of U.S. law.

This authorization is to remain in full force and effect until Creative Kids Inc. has received written notification stating a two-week termination date from the program.

Payment Security Notice: Credit card payments submitted through this form are processed securely through Stripe. Creative Kids Inc. does not receive or store your full credit card number or security code through this website.

Authorization Confirmation(Required)

I authorize Creative Kids Inc. to process payments according to the selected payment schedule.

Parent Signature(Required)

Signature Date(Required)

Credit Card Payment Authorization Form

Creative Kids Online Payment Authorization Form

Authorization Agreement

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