Name: Will & Will
Address: 701 5th Ave #3510, Seattle, WA, 98104
Telephone: 206-209-5585

Automatic Payment Form

Client Automatic Payment Authorization
Please fill out your credit/debit card information below to authorize Will & Will, PLLC to automatically charge your card on the dates/amounts described in the Retainer Agreement, and/or as authorized for Investigation/Expert Fees. Please note this secure form does NOT store your full credit card number on file with our firm. Further, this form does NOT charge your card. For your first online payment with our firm, you will still receive an initial invoice from SQUARE to pay online. Subsequent payments will be automatically deducted and you will receive electronic receipts from SQUARE. If you are filling this form out for Investigation/Expert Authorization, your card will charged pursuant to the terms outlined in the Investigation/Expert Form you filled out.
Today's Date*
MM slash DD slash YYYY
Are you the Client or the Co-Signer?*
- Client
- Co-Signer
Your Name*
First Last
Client's Name*
First Last
Name*
First Last
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Information
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
AUTHORIZE*
- I hereby authorize WILL & WILL, PLLC to automatically charge the credit/debit card above in the amounts and dates specified in the Retainer Agreement and/or for pre-approved Investigation/Expert Fees.

Payment Form

Client Automatic Payment Authorization