By signing this form, I hereby authorize Excel Media Group to charge my credit card on a monthly basis for the amount selected, to continue until cancelled by me in writing.

I understand that this authorization permits Excel Media Group to store my credit card information for future transactions and to process recurring monthly payments using the provided credit card information.

This information will be stored in compliance with all relevant data protection laws and will be used solely for the purpose of processing transactions with Excel Media Group.

I further understand that I may also revoke this authorization at any time by contacting Excel Media Group via email at

Card Holder Name(Required)
Plan Details
Choose a Plan(Required)
Choose any additional plan
Note: You must Select a plan for each service or fill out an amount in "Other" you would like us to deduct monthly.
Card Type(Required)
Complete Billing Address(Required)

By signing below, I acknowledge that I have read and understood the terms outlined above, and I agree to allow Excel Media Group to charge my credit card monthly.