Auto Pay Authorization EMPLOYER PAY I/We authorize the Springfield Parking Authority to charge the credit card shown below on a monthly basis. This authority will remain in effect until I/we notify the Springfield Parking Authority within 30 days in writing to cancel this agreement. Springfield Parking Authority also reserves the right to cancel this agreement at anytime without notice. I / We understand that the credit card payment will be processed on the 1st business day of each month.Name of CompanyCompany AddressCity State ZIPTelephone #Number of ParkersGarageAccount#Name of ParkerName of ParkerName of ParkerName of ParkerName of ParkerName of ParkerStart DateEnd DateCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Billing AddressCity State ZIPEmail Address Amount $Auto Pay Update Yes No SignatureDate Date Format: MM slash DD slash YYYY
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