Fraud Blocker Client Billing Authorization Form - Adentities
Adentities
  • Data
    • AudienceID™ (AID)
    • Audience InMarket™ (AIM)
    • Data Order Form
  • Services
    • Adentities Accelerator (A²)
    • Adentities Outbound™ (AO)
  • About
    • Case Studies
    • Press
    • Blog
  • Book
    • Book a Sales Demo
    • Book a Team Meeting (Clients Only)
  • Contact
Book a Demo
Adentities - REDUCE ad costs UP TO 80%

Client Billing Authorization Form

  • Home
  • Client Billing Authorization Form

"*" indicates required fields

It is understood and acknowledged that all monthly service clients must have an automated form of payment on file at all times. To that end, we hereby request that "Adentities, LLC" (Company) use the following automatic form of payment to pay for any amounts owed them.

Address*

Pay with Bank Transfer Form

By default clients pay all agency fees via bank transfer / EFT

Please enter a number from 100000000 to 9999999999.
Are We Managing any type of Paid Ads Campaign (Google, FB, etc) For You?*

Credit Card for Ad Spend Only

Credit Card Authorization

Card Type*
3 digit verification code on the signature strip (4 for American Express)
Reset signature Signature locked. Reset to sign again
Credit Card Authorization and Acknowledgement*
Order Authorization & Acknowledgement*
This field is for validation purposes and should be left unchanged.

Subscribe to Our Newsletter

Adentities Logo

Adentities brings big data technology with real Artificial Intelligence to improve your website customer identity & online tracking. We collect more data and install systems that deliver more sales, higher conversion at a predictable lower price forever.

Company

  • Home
  • About
  • Contact

Services

  • Book a 15 Min Demo
  • AudienceID™
  • InMarket™
  • A² Program
  • A² Program Application
  • Adentities Outbound™

Legal Pages

  • Data Services Agreement
  • Marketing Services Agreement
  • Terms and Conditions
  • Privacy Policy

Adentities © 2023. All Rights Reserved

By browsing this website, you agree to our privacy policy and terms & conditions.
I Agree