Starry Eyes Media

Automatic Payment Authorization Form

By completing this form, you authorize regularly scheduled charges to your Credit Card. Starry Eyes Media, LLC will charge the amount indicated below each billing period and provide you with a receipt for each payment. Each charge will appear on your Credit Card Account Statement or Bank Statement. You agree that no prior notification will be provided unless the date or amount changes, in which case you will receive notice from us at least ten days prior to the payment being collected.

Your Information


Billing Arrangement

Enter the monthly amount your agree to pay. Please note, this amount should reflect the price of your chosen monthly package. If it doesn't, you'll have to resubmit this form with the correct amount.
Choose your desired bill cycle date

Credit Card Details

Be sure to enter the address associated with your credit card. If you enter the wrong address, we will not be able to process you payment.

By submitting this form, you attest that you are an authorized user for the supplied credit card, and you authorize Starry Eyes Media, LLC to charge on a monthly basis that same credit card for the amount specified above beginning on the bill cycle you selected. The first charges will occur on the next bill cycle date. Upon my acceptance of quotes for various projects associated with services such as graphic design, printing, web development, and photography, I also authorize Starry Eyes Media, LLC to charge my card below in accordance to the terms set forth in each of the quotes I accept. I understand that Starry Eyes, at its sole discretion may require an alternative payment for project charges, such as check or ACH.