Credit Card Authorization


I, _______________________________________________ AUTHORIZE TM MEDIA CORPORATION

                PRINT Name as it appears on Credit Card



TO CHARGE MY CREDIT CARD _________-_________-_________-_________,       ____/____,

                                                                              Credit Card #                                                           Exp



_______________                  FOR THE AMOUNT OF $__________.

    3 Digit Code




Billing Address:   Street Address                                                    City                                           State            Zip




This credit card charge covers payment for my specific advertising request below: 


Type of Ad:                STANDARD                       THUMB     OTHER   _________________________


Time Contracted: ____________   Beginning Date _____________  Ending Date ___________________


Ad Rate: ______________________          




I AUTHORIZE TM Media to charge my above credit card on the  ________ day  of every __________ 


for the amount of $_____________________


to cover my advertising fees for the above ad request until further notice.



I understand these charges made to my credit card will cover the required fees pertaining to the ad creation & ad placement on Website ONLY. If for any reason, I decide to discontinue my “Ad Run” on, I understand all “frequency discounts” I may have earned will be prorated to reflect the actual time period my ad ran. I also understand all payments are final once my ad run begins, and, all ad cancellations for any reason will be entitled to “Time” credit ONLY!


Please keep my Signature/Credit Card Info on file for future Advertising Requests.




______________________________________                        _ _/_ _/_ _ _   


Signature                                                                                        Date