SECURE CHECKOUT
ERRORS AND COMMISSIONS INSURANCE & REAL ESTATE TECHNOLOGY FEE
By signing this form, you authorize us to make a one-time charge to your credit card or bank account listed above. This authorization is for single transactions only and does not permit any other unrelated charges or credits to your account.
$100.00 - Charged Monthly
I hereby certify that I am the holder of the credit card and bank account detailed above and will not dispute the payments with my bank or credit card issuer, provided the transactions comply with the terms specified in this authorization form.