NATOLI-LEGAL, LLC
305 Broadway, 7TH Floor, New York, NY 10007
(212) 537-4436

Secure Payment Page

CREDIT CARD AUTHORIZATION FORM
NOTE : Please note that this is not an automated payment system. We will not charge your credit card until  you have had a consult with one of our attorneys.
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BY COMPLETING AND SENDING THIS AUTHORIZATION FORM TO US, YOU HEREBY ACKNOWLEDGE, AGREE AND AUTHORIZE NATOLI-LAPIN, LLC, OR ANY OF ITS ASSOCIATES TO CHARGE THE APPROPRIATE SERVICE FEES TO YOUR CREDIT CARD OR DEBIT ACCOUNT.
Name (As it appears on the card): *
Card Number: *
Type of Credit Card: *
Expiration Date: * /
CVC - Security Code: *
(Last three numbers located above or on the signature field on the back of Visa or MasterCard cards; the four digit code above and at the end of your credit card number on the front of your American Express card).
Billing Address: *
Street Address (Line 1): *
Street Address (Line 2):
Apartment or Suite Number:
City: *
State: *
Zip Code: *
Authorization:
BEING THE CARDHOLDER OR CORPORATE OFFICER, BY INPUTTING MY NAME BELOW I UNDERSTAND AND AGREE TO PAY AND SPECIFICALLY AUTHORIZE NATOLI-LAPIN, LLC, OR ITS AUTHORIZED AFFILIATE TO CHARGE MY CREDIT CARD, FOR LEGAL SERVICES PROVIDED.
E-Sign Name: *