EmailMe Form - Credit Card Authorization Form

Name on Credit Card *
First Last
Legal name as on government issued identification.
Billing Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Please enter the address that is on file with the card.
Cardholder Phone Number *
### - ### - ####
Email *
This will be used for mailing any electronic documents/itineraries.

Confirm
Office Name(s) *
Payment Details
Please provide payment details below
Credit Card *

Card Number

Protected in vault Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Authorization of Charges *
I authorize
As named Cardholder; I Authorize: Advanced Marketing Services to provide this credit card information to Google and/or Facebook for Paid Ads services.
Google Billing Cadence *
I understand that AMS has no control over Google or Facebook's billing dates/times, and amounts. Google will fund your paid ad account and place charges according to your set budget.