Card Authorization

I understand that this authorization will remain in effect until my Services Agreement is terminated in writing, and I agree to notify ChiroPraise in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing cycle after any minimum contract period. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form. I understand and agree that if ChiroPraise places my account with a collection’s agency or a law firm for collections that ChiroPraise shall be entitled to collect from me all collection costs to the extent allowed by applicable law. My submission above encompasses acceptance for the entire agreement, including payment authorization. If a change is needed to a payment method, please reach out to your account manager.

Please notify us in the event that you need to update the card on file prior to your billing date.