Netspend Return Authorization Form

Credit Card Authorization Netspend Redemption Form

By agreeing to this form I ("Recipient") give the company ("Wing Seven") permission to debit my account for the amount indicated on or after the indicated Date of Agreement. This is permission for a one time charge, and does not provide authorization for any additional unrelated debits or credits to my account. I authorize Wing Seven LLC to charge my credit card account indicated below for $58.00 on or after the Date of Agreement. All charges are related to the Wing Seven Standard Rapid Retirement Program and applicable transaction fees only. I hereby authorize Wing Seven LLC to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.
  • Entering your name above shall constitute your electronic signature. This is the legally binding party ('Recipient") in this agreement.