Frank’s Tax & Business Service

Franklin Katz, ATP, PA, PB

120 York Road

Kings Mountain, NC 28086

Merchant #: 8788260163373

Credit Card Authorization Form

Cardholder Name: ________________________________

Credit Card Type (check one):   Visa __           MasterCard __

Credit Card #: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

Credit Card Expiration Date:  _____ / _____

Credit Card Security Code (from back of card): _________

Billing Address: __________________________________

Telephone Number: (____)____-_____

As the card holder, i authorize Frank’s Tax & Business Service, to charge my credit card the following amount: $_______

(plus a 2.25% administrative fee)

I understand that all information above is to be held with Frank’s Tax & Business Service, and will be kept strickly confidential.

Signature: ____________________   Date: ____________

Please remit this form via

Email to frankstaxservice@bellsouth.net.   fax to

704-739-3934), or Mail to 120 York Rd, Kings Mountain, NC 28086-3151