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One Time Credit Card Payment Authorization Form

Complete this form to authorize C-TEC Solar, LLC to make a one-time charge to your credit card listed below.

By completing this form, you give us permission to charge your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account. CTEC Solar will charge your card only after the completion of services.

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Order Number

I authorize C-TEC Solar, LLC to charge my credit card for services rendered from my O&M Work Order.

I agree

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Account Type

Cardholder Name

Card Number

Expiration Date

CVV Code