RECURRING PAYMENT AUTHORIZATION FORM
PHCC offers the option to pay dues in quarterly or annual installments. Installment payments require authorization to implement automatic recurring credit card payments. Please complete this Authorization form and we will automatically process your payment as requested and email a confirmation receipt. Please return this form, dues amounts, and installment option via mail: 9920 Scripps Lake Drive, Suite 102, San Diego, CA 92131 OR email to email@example.com
Here’s How Recurring Payments Work: You authorize regularly scheduled charges to your credit card. You will be charged the amount indicated each billing period. A receipt for each payment will be emailed to you and the charge will appear on your bank statement. You agree that no prior notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.
Please complete the information below: