Co-Parenting Solutions, LLC

4. Credit Card on File Policy

At Co-Parenting Solutions, LLC, we offer to keep your credit or debit card on file as a convenient method of payment for services. This allows us time to focus on our work together when we meet. You will be billed only after an appointment or work completed for your case. Your credit card information is kept confidential and secure.

Cancellation Policy

Sessions must be cancelled at least 24 hours in advance. I authorize Co-Parenting Solutions, LLC to charge a late cancel/no show fee for the full session price if adequate cancellation notice is not given.

I authorize Co-Parenting Solutions to charge any bill that is my financial responsibility to the following credit or debit card:

Card Type:
Card Number:
Expiration: CVC: Zip Code:  
Cardholder Name:
Cardholder Email:

I agree to promptly notify Co-Parenting Solutions, LLC if my credit card expires or a get a new credit card. In the event there is an outstanding balance on my account when a credit card expires or is not available for payment, I agree that no appointments will be made for sessions until the new credit card information is given to Co-Parenting Solutions.

This authorization will remain in effect until I cancel this authorization. To cancel, I must give written notification to Co-Parenting Solutions, LLC and the account must be in good standing.

Client Name:

Date Signed:

Revised 12/2019

Leave this empty:

Signature arrow

Signature Certificate
Document name: 4. Credit Card on File Policy
lock iconUnique Document ID: d8ad5461ef32e6951b258ab1e9e001913e931842
Timestamp Audit
July 23, 2020 4:12 pm EDT4. Credit Card on File Policy Uploaded by Jordana Wolfson - IP
August 18, 2020 10:09 am EDT Document owner has handed over this document to 2020-08-18 10:09:16 -