Payment Authorization


Please review the following information you’ve submitted. If everything looks correct, please sign and submit your payment authorization below. You can print a PDF of your document or receive an email confirmation after clicking submit.

 

 

I authorize Delco Innovations & Trend Medical, LLC to keep the above listed credit card on file for payment per our contractually established payment terms or to electronically debit the above listed bank account according to our contractually established payment terms.

 

 

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Trend Medical https://trend-med.com
Signature Certificate
Document name: Payment Authorization
lock iconUnique Document ID: ddfc1895b2d0889c7ac80eb4fb31de3cf6379ba4
Timestamp Audit
April 8, 2020 3:09 pm EDTPayment Authorization Uploaded by Brandon Boyer - billing@delcoinnovations.com IP 173.49.217.105