Payments Dashboard Credit Card Authorization Form Please complete the form below to authorize your credit card payment securely Company Name(Required) Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dealership(s) this payment method applies to:Email Address for Receipts / Invoices(Required) Card Type(Required)Card TypeVisaMastercardAmerican ExpressDiscoverCardholder Name (as shown on card)(Required) Card Number(Required) 3/4 Digit CCV(Required) Expiration Date (mm/yyyy)(Required) Cardholder Zip Code (from credit card billing address)(Required) Authorization(Required) I authorize OneKeel.ai to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account. I have reviewed my pricing schedule and agree to all one-time and recurring platform charges. I understand that my lead generation charges may vary in quantity and price. I understand that an invoice will be provided to me by email prior to my card being charged. I understand that this authorization will remain in effect until I cancel it in writing. I agree to notify OneKeel.ai in writing of any changes in my account information. If the periodic payment dates fall on a weekend or holiday, I understand that the payment may be executed on the next business day. In the case the credit card declines, I understand that OneKeel.ai may at its discretion attempt to process the charge again within 30 days. A 3% processing fee will apply to all transactions. Date(Required) MM slash DD slash YYYY SignatureSignature(Required) Administrator Login