{{Recurring Orders}}
Automatic Renewal Recurring Order Form
If you want to have a recurring order please return this form by email to cs@timetravelercorp.com or by mail to
Time Traveler
Location
4491 Waterside Drive
Fort Lauderdale, FL 33309
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Recurring Payment Authorization Form
If 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.
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Customer Name as used for Order ...........................................................
Email address ..........................................................................................
Time Traveler
Email
cs@timetravelercorp.com
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Payment Information
I authorize Time Traveler to automatically bill the card listed below as specified:
Executive Diary ................................................ Desk Diary ................................................
Medium Weekly Diary .................................... Pocket Diary ............................................
Annually x Start on Month ____ Year ____
choose End Date Month ____ Year ____
OR ________________________ No end date
Credit Card Information (to be completed by customer)
Card type (Choose one)
.............. Master Card
.............. Visa
.............. Discover
.............. AMEX
Cardholder name (as shown on card) .........................................................................
Cardholder ZIP Code (from credit card billing address) .........................................
Card number ..........................................................................................................
Expires Month ____ Year ____
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 ..............................................................................................
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