Client Name (required)
Your Name (required)
Your Email (required)
*Note: If you are not sending money for either money on books OR service payment, place "$0" in the box
Money On Books:
By checking this check box, I authorize the above named business 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. I understand and agree that StepHouse Recovery Center will not be issuing any refunds/pro-rations under any circumstances.