Credit Card Consent Form

This page is a secured and encrypted Credit Card processing page that will provide the maximum protection for our valued clients. This page is SSL compliant, HTTPS protected with a valid SSL certificate.

Please fill out the CC information below.
(Fields marked * are required)
Cardholder Name*
First Last
Company Name
Service Requested
Cardholder Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email Address*
Card Provider*
Type of Credit Card: (Select one)*
Card Number (no spaces)*
Security Code/CVV*
Expiration Date*
Month Year
Amount in USD
Comments
Billing Information
Billing Contact Name*
Contact Email*
Contact Phone Number*
Any specific billing instructions
Is the address above used for billing purposes Y or N?*
- Yes
- No
Billing Address*
Street Address City State / Province / Region ZIP / Postal Code Country

The client agrees to have AML-Global authorize the credit card for the estimated charges. If the project is approved, client agrees to allow AML-Global to charge the full amount on the card.

To use a different method of payment, please contact us at 800-951-5020 or by email at accounting@alsglobal.net, to make further arrangements. Please note that any modification to the payment method must be in writing and confirmed by an authorized representative of AML-Global.

Billing Information

WE ACCEPT ALL MAJOR CREDIT CARDS