Alan Behrman & Associates, PC

    2876 Johnson Ferry Rd., Suite 150 Marietta, GA 30062
    1041 Cambridge Square, Suite A Alpharetta, GA 30009

    Credit Card Authorization Form

    *This form is completely confidential*

    Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.

    Credit Card Information


    to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.