I, Your Name *, authorize New Image Works to charge my card, VISA Mastercard Amex Other Card Type with the LAST 4 DIGITS Last 4 digits* for services received by another person Client's first name Client's last name in the amount of $ Amount* . In case you need to contact me please call at Phone Number* , or email me at Email . My billing address is Street Address Address Line 2 City State Zip .I agree to pay for this purchase in accordance with the issuing bank cardholder agreement.I also understand I am waiving my right to dispute this charge with my bank for claims of services not received by cardholder or other similar claim of non-service.