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Monthly Credit Card Authorization Form

I ____________________________ , of ___________________________ (Cardholder Name) (Company Name)

Do hereby authorize the Locapon Inc. to apply any Advertising/Marketing costs incurred by me to the credit card listed below. I understand that these charges will be applied to my credit card each month when invoiced.

Further I will notify Locapon Inc. accounting Department of any changes to my credit card information immediately ( i.e. change of name, address change or expiry date change etc.).

This agreement is in effect until further written notice to Locapon Inc. In the event my credit card is declined, I will provide payment to Locapon Inc. within three (3) business days upon notification. Failure of prompt payment will lead to an Advertising/Marketing hold and possible collection action.

If you have any questions please call us at 1-855-845-1220 or fill out the form below.