Payment Authorization - B&J Wakefield Services

Credit Card Information

Please complete all fields accurately. Once submitted, this authorization will remain in effect until your service agreement is terminated. Please contact us with any payment method updates or questions about your purchase.

Name *

First

Last

Phone Number *

Email *

Service Plan Purchased *

Service Address *

Service Payment Type (select one) *

Pay in Full (Annual)
Pay Monthly

Cardholder Name (as shown on card) *

Card Number *

Security Code *

Expiration Date *

Billing Address *

Apt./unit number

City *

State *

Billing ZIP Code *

Payment Authorization *

I authorize B&J Wakefield Services to charge my credit card above for agreed upon purchases. I understand that my information will be saved on file for future transactions on my account.

Credit Card Information

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