Sunshine Publishing

1851 Bowler Drive, Pickering, On L1V 3E5

Toll Free: 1-800-330-5709Fax: 905-831-2062

Credit Card Authorization Form

Please fax this authorization form and mail original to above address. Please do not e-mail sensitive information.

	Customer Information
		Name: (as it appears on card)  ____________________________________________________________
		Business Name:   _____________________________________________________________
		Address:   ___________________________________________________________________
		City/Town:   __________________________________________________________________
		Province/State:   _______________________________________________________________
		Postal /Zip Code:   _____________________________________________________________

	Res. Phone: (     ) _______________	Bus. Phone: (     ) _______________
	Cell Phone: (     ) _______________	Fax: (     ) _______________
	Email Address:   _____________________________________________________________
	Website Address:   ___________________________________________________________
	I hereby authorize Homes Newspaper to debit my Credit Card account in the amount of ____________ for each issue published. I understand that monthly payments will be debited on the 1st day of each month. This authority shall remain in effect unless and until I give Homes Newspaper written notice of termination at least 1 month prior to payment date. Absolutely no refunds are permitted once papers are printed.
	Visa:   _______________________________________	Expiry: _____/_____
	Master Card:    _________________________________
	American Express:    _____________________________
	Signature:    _____________________________	Date:   _____________________________