Pay for Advertising - Westmoreland Gold 98.7fm, 910am, 1480am

Credit Card Authorization Form

Electronic Payment Authorization Form

*All fields are required.

Advertiser Name:

Contact Name:

Billing Address:

Zip Code:

Business Phone Number:

Email Address:

Payment Method:

Recurring Monthly Payment

One Time Payment

CC Type:

Visa

American Express

Master Card

CC Number:

Expiration Date:

CVV:

Invoice Number:

AMOUNT TO CHARGE:

Comments:

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I authorize Maryland Media One, LLC, operator of MD News Network, Radio PA and WHGM-AM/FM to automatically bill my credit card for payment of advertising services. I understand that I will be billed for each month that my campaign is active, until expiration date or I notify Maryland Media One, LLC