Payment – Canine Chronicle TV

Advertising Payment Form

Advertising Credit Card Authorization, please fill out the following Secure-Online order form.
All areas with asterisk (*) MUST BE FILLED.
All payments are non-refundable once submitted.

Advertising Info*
First Last
Billing Information*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Sign me up for The Canine Chronicle newsletters & reminders
- Sign me up
Sign me up for The Canine Chronicle newsletters & reminders
Credit Card Type*
- Amex
- Visa
- Mastercard
- Discover
Debit and Check Cards Must Have Limits That Will Accept The Full Amount Of The Charge
Name on Card*
First Last
Number*
CCV Number*
Exp. Month*
Exp. Year*
Please note that we do not accept multiple-pay orders or Electronic Check transactions. In addition, we are not responsible for any overdraft fees or other bank charges you may incur as a result of your advertising purchase.
Mailing Information (If Different or International)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Notes
Electronic Signature & Verification*
- I Authorize
Checking this box verifies this as my electronic signature. By submitting this form I hereby authorize The Canine Chronicle to keep my credit card payment information on file.
Name
This field is for validation purposes and should be left unchanged.