Billing & Recurring Payment Form

This is a secure page that will allow you to safely enter credit card information. You can also call our office at 816-476-7776 to set up a payment option.

Please fill out the credit card authorization form below.

All hourly or project invoicing will not be automatically charged to the card on file unless authorized. These charges would only be for all monthly, quarterly, and yearly recurring charges.

Cards on File will be used for:

* Recurring payments -This would include things such as domain renewals, hosting renewals, SSL certificate renewals, and quarterly security updates.

Credit Card on File – What are the benefits to me?

Customers who have a credit card on file will no longer have to worry about statements and mailing in payments. Having a credit card on file will make the will make the billing process easier, faster and more efficient.

How does this work?

We will ask you to sign a “Credit Card Billing Authorization”. As part of the agreement, you will be able to set a maximum amount that can be charged to your card. A receipt will be emailed to you after the payment has been processed. If the payment is declined, we will request updated credit card information or an alternative form of payment.

How can I be assured that my credit card information will remain safe?

Intuit, our credit card processing vendor, will store your information on a secure and encrypted site, which will enable us to run bank card transactions through our computer system. No employees will have access to your bank card information. No credit card information will be stored in or at our office.

Why have I never had to do this before?

This may be different from what you have always been used to, but it is becoming common practice in many businesses. Many, if not most, local service providers now require a credit card on file, and payment at the time of service. This policy is being instituted in order to simplify and enhance your customer experience.

What if I have more questions?

Our staff is available to speak with you about your account at any time during regular business hours, (816) 476-7776.

Business Name*
Credit Card Type*
Credit Card Number*
Expiry Date*
Cardholder's Name*
First Last
(As shown on card)
Billing ZIP Code*
ZIP / Postal Code
Card CVV Number*

(3 or 4 digit code on back)
Confirmation*
- I agree to the terms above, and approve this credit card to be used for all recurring payments. I understand Elemeno Digital will set up your automatic payments for recurring services only. I understand total charges will appear on my monthly credit card statement and I will also receive a paid receipt for all charges.
E-Signature*
Print Name*
Date*
MM slash DD slash YYYY

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