New Client Form

Elite Media Design Credit Card Authorization Form

Please Fill out the form below in order to get your Account setup with our company. This information is store in a secure file for you and is never shared with anyone. We will only use this information for billing purposes.

I, hereby authorize Elite Media Design (an Elite Apparel, LLC Company) to charge my credit card for the amounts invoiced each month or each time an order is placed.
Company Name
Credit Card Type
Credit Card Number	Expire Date Security Code
Street Address	City State Zipcode
Phone	Email
Client Sign	Todays Date By Typing your name in the Client Sign box above it is considered a digital signature.



As the credit card holder, I also authorize Elite Media (an Elite Apparel, LLC Company) to charge my credit card for future purchases verbally (or written) approved by me. Your completion of this authorization form helps us to protect you, our valued customers, from credit card fraud. Elite Media (an Elite Apparel, LLC Company). will keep all information entered on this form strictly confidential. Yo here by certify that you are the personal that is authorized to charge this Credit Card and any and all charge or fees may be added to your order if legal action is required.