EmailMe Form - Credit card details

Set up your auto-payment credit card

The information entered here is securely stored on a PCI-compliant partner.

Service address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Your email address *

Your name (the way it appears on the credit card) *

First Last

Credit Card *

Billing zip code *

Authorize auto-payments for minor repairs.

Choose if you allow auto-payments, and for how much, to cover minor repairs. We will contact you prior to repairs exceeding this amount.

Do you authorize auto-payments for minor repairs? *

Agree to the billing agreement and submit

By submitting this form, I, the cardholder, acknowledge that the payments received by deposits and final payments, monthly service, repairs, or other confirmed services constitute acceptance of confirmed services by the cardholder. I verify that all information on this Credit Card Authorization is correctly provided and that I am the cardholder of the above credit card. By submitting I, the above cardholder agree not to request any charge back on the credit card until any disputed matters are resolved with AZ’s Best Pool Service & Repair, L.L.C.. I further verify that the signature above is my signature as indicated on the reverse of the above-indicated credit card.

Should the Customer choose not to keep the Credit Card on file, AZ’s Best Pool Service & Repair, L.L.C. requires the first & last month's payment before pool service begins. All repair work must be paid in full at completion if no credit card is on file.

Signature *

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