By signing and submitting this form, I authorize Vitality Medical Marketing Group, a DBA of Efferent Media (“Agency”), to charge the credit card provided for services rendered pursuant to my signed Order Form(s) and the Master Services Agreement (“MSA”). This authorization includes, but is not limited to, monthly marketing and management fees, software and CRM fees (including RootLogic), and advertising-related charges placed on my behalf with third-party platforms such as Google, Meta (Facebook/Instagram), Microsoft/Bing, and other approved vendors. I further authorize Agency to process charges necessary to correct or resolve failed, declined, or outdated payment methods associated with these services. All charges authorized under this agreement shall remain consistent with the terms, scope, and fee structure outlined in my Order Form(s) and the MSA.

I understand and acknowledge that advertising spend is my responsibility under the MSA and Order Form. Third-party advertising platforms may bill charges directly to my credit card, or Agency may process such charges on my behalf. I remain responsible for all approved advertising costs and related fees regardless of whether such charges are billed directly by the platform or through Agency.

I understand and agree that charges may appear on my credit card statement under either of the following merchant names: Vitality Medical Marketing Group or Efferent Media. I acknowledge that both names represent the same authorized service provider, that I have been informed of these billing descriptors prior to submitting this authorization, and that either descriptor constitutes an authorized charge under this agreement.

I understand and agree that this authorization permits recurring charges without separate authorization for each individual transaction. I further acknowledge that charges may be variable in amount depending on approved management plans, advertising budgets, software subscription levels, platform requirements, or performance-based adjustments. Third-party advertising costs may fluctuate based on approved ad spend and market conditions. I am responsible for maintaining sufficient available funds and valid payment information.

This authorization shall remain in effect for the duration of services under the MSA, including any renewal terms, unless revoked in writing in accordance with the MSA. Written revocation must be submitted at least ten (10) business days prior to the next billing date and does not waive or cancel any outstanding balances, accrued fees, or contractual obligations.

I understand that failure to maintain valid payment information or sufficient available funds may result in suspension of services, late fees, collection efforts, or additional costs as permitted under the MSA and my Order Form.

By signing below, I agree that I am the authorized cardholder or have authority to use this card for the business listed. I acknowledge that the charges described herein are authorized and relate to services rendered pursuant to my signed Order Form(s) and the MSA. I agree not to initiate a chargeback for properly authorized charges and understand that initiating a chargeback for a valid and authorized transaction may constitute a breach of my agreement. Any billing concerns will first be addressed directly with Agency prior to contacting the issuing bank. I understand that unauthorized chargeback disputes may be considered a breach of my agreement.

I certify that the information provided is accurate and complete. I authorize Agency to charge this credit card in accordance with this agreement. I understand that this document constitutes written authorization for recurring and variable credit card charges under applicable card network rules.