Checking this box will prevent the need for this form to be completed for each payment. You will still be contacted prior to processing payments on this card to ensure agreement of payment amount. If you prefer not to be contacted prior to each payment, please initial below. Any disputed charges will be handled as a separate transaction and it is understood that any refunds that may be due, may be sent back in the form of a check or wire payment and not necessarily as a credit to the credit card. (No contact required)