MarketCounsel | The Adviser's Advisor - Business and Regulatory Compliance Consulting Firm

Credit Card Authorization
We want to make paying for our services as easy as every other aspect of our relationship. Therefore, we offer several convenient options including major credit cards. To charge your card, please print, complete, and fax us the following authorization. For additional methods of payment, please download our Payment Remittance Form.

I authorize MarketCounsel, LLC to charge my as follows: AutoPay* one time for the amount due. one time in the amount of $.
Client name (firm)
Cardholder name
Billing Address

Account #	Expiration
Date:	Signature:

Please complete and print this form. Then fax it to us at (201) 836-8815.

* For your utmost convenience, check the box to enroll in AutoPay, our automatic payment program where we debit your credit card for open balances. Under AutoPay you avoid the hassles of writing checks but continue to receive invoices showing the details of our billing without any balance due. You may cancel your participation in AutoPay at any time by providing us with written notice.