SMA ALLIANCE Strategic Marketing Auto Alliance

Online Payment

Please note that on your credit card statement, all charges will be deducted from our S.M.A. Alliance.

Dealership Name: *

Card Type: *

Please select one of the following choices.

Credit Card Number: *

Please insert your credit card number as it appears on the card.

Expiration Date: *

Please use MM/YYYY format.

Security Code *

For American Express, this is the 4 digit number located on the front of the credit card. For Visa, Mastercard, and Discover, this is the three digit number located on the back ot the credit card.

Name As it Appears On Card: *

First

Last

Billing Address: *

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

This is the address that the credit card statements are sent to.

Authorized Amount: *

Please enter the dollar amount authorized to be charged by S.M.A. Alliance for services.

Dealership Signature

Please digitally print your name and initial your signature authorizing S.M.A. Alliance to process your credit card for services.

Authorized Signer Name: *

First

Last

Position:

Digital Signature: *

Please use your initials to digitally sign this credit authorization form.