Please sign and complete this form to authorize Ears of Experience to make monthly/weekly debits to your credit card listed below.

You authorize regularly scheduled charges to your credit card. You will be charged the amount indicated below each billing period. A receipt for each payment will be provided to you and the charge will appear on your credit card statement. You agree that no prior notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.

Client Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Payment Information

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVV Code *

Amount to be charged weekly/monthly *

Description of goods and services *

First date of payment * +

*

Weekly

Monthly

Name of my Ears of Experience Agent *

Credit Card Authorization *

I authorize the above-named agent with Ears of Experience to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for monthly payments. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Future Transactions *

If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I acknowledge that the origination of Credit Card transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this Credit Card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this authorization form.

I understand that my credit card information will be saved to file for future transactions on my account.

Please add your credit card information to your “My Disney Experience” account profile for Advance Dining Reservation bookings. The costs for these reservations will vary and you will be notified of the price before making any such reservation. These reservations can be seen in your My Disney Experience account after they are booked. Make sure to check your reservations in your account and make any changes or cancellations at least 24 hours in advance (for most dining reservations) to avoid unnecessary credit card charges. Keep in mind that dessert parties have a 5-day cancellation policy while dinner shows, and Cinderella’s Royal Table have a 48-hour cancellation policy.