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Automatic Renewal Recurring Order FormIf you want to have a recurring order please return this form by email to cs@timetravelercorp.com or by mail to Time Traveler4491 Waterside DrFort Lauderdale FL 33309Recurring Payment Authorization FormIf you would like to enjoy the convenience of automatic recurring billing, simply complete the Credit Card Information section below and sign the form.All requested information is required.Upon approval, we will automatically bill your credit card for the amount indicated and your total charges will appear on your monthly credit card statement. You may cancel this automatic billing authorization at any time by contacting us. Customer Name as used for Order Email address________________________________________Time Traveler
cs@timetravelercorp.com
Payment Information
I authorize Time Traveler to automatically bill the card listed below as specified:Executive Diary Diary Diary Medium Weekly Diary Pocket Diary Annually xStart on / Month Yearchoose End Date / OR No end dateCredit Card Information (to be completed by customer)Card type (Choose one) MasterCard Visa Discover AMEXCardholder name (as shown on card)Cardholder ZIP Code (from credit card billing address)Card number
Expires / CCV CODE
We will email you when credit card is charged. This will happen in advance of shipment as we prepare our recurring orders ahead. (Make sure email address above is correct.)Customer’s signature