BLUE RIDGE - One Time Payment Authorization

Billing Address *

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Payment Amount *
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Deposit Final Payment Other
Card Info
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Authorization/ Acknowledgement
Authorization: *

By submitting this form, I do hereby authorize Dan Pril and/or Blue Ridge Tree Services to charge the above card immediately in the amount indicated. Dan Pril and/or Blue Ridge Tree Services assume no responsibility for changes made to a proposal if the payment fails to process. I am also acknowledging that I am the cardholder held under penalty of law.
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One Time Payment Authorization