Mediation Mastery III
June 30th, 2022
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IMPORTANT:
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- Payments processed after 6:00 p.m., and on weekends, will not be posted until the following business day.
- By completing this form, you are authorizing Private Corporate Counsel to use this card to pay for the legal services being provided to you, person, and/or business entity listed in the Attendee Name field of this payment form.
- All payment amounts are processed in U.S. dollars.
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Attendee Name:
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| Payment Date: |
04/20/24
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| *Attendee Name:
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| Webinar Cost: |
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| $275.00: |
Enter Number of Attendees. |
| Total Charge : |
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Credit Card Information:
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*Card Type:
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*Card Number:
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*Card Expiration
Date:
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MMYY
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*Card ID (CVV2/CID) Number:
[What is the Card
ID?] |
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*Cardholder Name
(Name as it appears on card): |
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| *Card Billing Address: |
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| *Card Billing City: |
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| *Card Billing State: |
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| *Card Billing Zipcode: |
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| *Email Receipt To: |
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*I agree to the terms and conditions:
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By submitting this form, you hereby authorizes Private Corporate Counsel to charge against said card the following one time charge for legal services and/or costs provided to and/or on behalf of the above client. Your agreement to pay the Clients fees and costs does not authorize Private Corporate Counsel to disclose any information to him/her about the Client without the Clients approval. |
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PRIVATE CORPORATE COUNSEL
201 E. Pine Street, Suite 445, Orlando, FL 32801 Tel. 407.647.7887 Fax 407.647.5396
privatecorporatecounsel.com
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