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.